bluuebunny/crossref_metadata_2025 huggingface dataset:
Massive Posterior Fossa Tuberculous Abscess Developing in a Young Child Treated for Miliary Tuberculosis
Authors: Schoeman J.F. , Morkel A. , Seifart H.I. , Parkin D.P. , van Helden P.D. , Hewlett R.H. , Donald P.R.
Published: April 2003

A 21-month-old infant presented with acute obstructive hydrocephalus due to a large tuberculous abscess in the posterior fossa 3 months after starting treatment for miliary tuberculosis. Insertion of a ventriculo-peritoneal shunt resulted in some clinical improvement but subsequent neurological deterioration occurred due to massive enlargement of the tuberculous abscess despite apparently adequate antituberculosis therapy. Repeated drainage procedures of the abscess eventually resulted in resolution and clinical improvement. As part of the workup for poor weight gain and the unusual clinical course, the patient’s acetylation status for isoniazid was determined and found to be very rapid. Doubling the daily dose of isoniazid was followed by a dramatic weight increase and further clinical improvement. Decreasing the load of tuberculous antigen by draining the abscesses and increasing the pulse exposure of isoniazid is the best possible explanation for the clinical improvement finally seen in this patient.
Intracranial Germinoma Associated with Down’s Syndrome
Authors: Matsumura Nobuhisa , Kurimoto Masanori , Endo Shunro , Fukuda Osamu , Takaku Akira
Published: April 2003

It is well known that Down’s syndrome is sometimes associated with leukemia. However, there have been only a few case reports of a relationship between Down’s syndrome and brain tumors. We report 2 cases with histological diagnoses of germinoma. The 1st case was a 10-year-old boy with Down’s syndrome complaining of seizure and left hemiparesis. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed a mass lesion in the right basal ganglia and thalamus. Histological examination indicated two cell pattern germinomas. The 2nd case was a 20-year-old man with Down’s syndrome complaining of headache and vomiting. CT scan and MRI showed a pineal region tumor with marked hydrocephalus. Surgical specimens showed typical germinoma. Only 13 cases of brain tumors associated with Down’s syndrome have been reported. A higher incidence of germ cell tumors seems to be related to chromosomal abnormalities.
Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children
Authors: Roitberg Ben Zion , Tomita Tadanori , McLone David G.
Published: April 2003

The present paper is a retrospective analysis of 27 consecutive patients, treated for abdominal cerebrospinal fluid (CSF) pseudocyst at the Children’s Memorial Hospital in the years 1991–1996. This series is compared to the previous experience from our institution. Treatment consisted of the removal of the ventriculoperitoneal (VP) shunt and placement of an external ventricular drain. Antibiotics were administered intravenously for 10 days. The cysts were aspirated intraoperatively in 9 patients and postoperatively with ultrasound guidance in 3 patients, while they resolved spontaneously in 15 others. In 21 of 27 cases (78%), the shunt could be reinserted into the abdomen in a new location. Four patients had a ventriculopleural shunt, and in 2 patients, a ventriculoatrial shunt was inserted. Forty-four percent of the patients had a positive culture on presentation. The positive culture rate was 77% for those 4 years old and younger and only 28% for those aged 5 and above (p = 0.03). We conclude that abdominal CSF pseudocysts are resolved by externalizing the shunt. A VP shunt can be safely reinserted in the majority of the patients. Infection, while an important factor, is not likely to account for all cases of pseudocyst.
Pediatric Intracranial Epidural Abscess Secondary to an Infected Scalp Vein Catheter
Authors: Lefkowitz Michael A. , Chin Lawrence S. , Couldwell William T.
Published: April 2003

The authors present a case of a 5-week-old infant developing a retrotorcular epidural abscess as a result of an infected scalp vein catheter. The abscess developed in the absence of sinusitis, otitis, trauma, or prior surgery. The diagnosis of epidural abscess was made on the basis of magnetic resonance imaging and ultrasound-guided aspiration of the fluid collection. An identified strain of Staphylococcus epidermidis was cultured from both the intravenous catheter and the abscess. The patient underwent a suboccipital craniectomy with drainage of the abscess and a 6-week total course of intravenous antibiotics. Magnetic resonance imaging 4 months after the procedure and 2.5-year pediatric clinic follow-up have demonstrated no evidence of neurologic deficit or recurrence. When present, a scalp vein catheter must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.
Spontaneous Dural Sinus Thrombosis in Children
Authors: Lancon JohnA. , Killough KevinR. , Tibbs RobertE. , Lewis AdamI. , Parent AndrewD.
Published: April 2003

The clinical course of spontaneous dural sinus thrombosis in children varies from indolent to fulminant. Although many different etiologies for the development of dural sinus thrombosis have been described, a full recovery can be anticipated in most children following rehydration and the administration of systemic antibiotics. Steroids, systemic anticoagulation and intrasinus thrombolysis may be beneficial in selected patients, although the efficacy of these therapies has not been established prospectively in children. We reviewed 12 pediatric patients with spontaneous dural sinus thrombosis (1978-1998) to determine the etiology, clinical course and best treatment options. In the absence of a hypercoagulable state, pediatric patients generally recover well with rehydration and antibiotics and do not require anticoagulation.
Combined Posterior and Posterolateral One-Stage Removal of a Giant Cervical Dumbbell Schwannoma
Authors: Oruçkaptan H. Hakan , Gürçay Özdemir
Published: April 2003

Objective: Huge dumbbell schwannomas in the cervical region are not a rare clinical entity in neurosurgical practice. Despite the benign nature, the adhesions between tumor capsule and spinal cord, vertebral artery, cervical plexus, and carotid sheath can complicate surgery, leading to a fatal outcome. We performed one-stage combined surgery through the posterior midline and an unusual posterolateral cervical route in the same position and describe its advantages. Method: We removed the intraspinal component totally through a posterior midline approach and freed spinal cord and vertebral artery. After removal of the posterolateral extraspinal component using the same incision, a posterolateral cervical approach along the posterior margin of sternocleidomastoid muscle was performed, and the anterolateral extraspinal tumor was excised totally through the dissection plane between anterior and middle scalene muscles. Results and Conclusions: The operative time was less than 3 h, and the patient was discharged on the 3rd postoperative day without any neurological sequel. The combination of posterior midline and posterolateral approach in large dumbbell schwannomas is easier to perform and a more safe technique than the combination with anterolateral accesses in the cervical region and also less invasive than the transuncodiscal technique in selected cases. This approach reduces the risk of neurovascular injury, since it does not require retraction and repositioning of the patient and, therefore, facilitates total excision and reduces the operative time.
Intracavernous Teratoma in a School-Aged Child
Authors: Becherer Thomas A. , Davis Daron G. , Hodes Jonathan E. , Warf Benjamin C.
Published: April 2003

An eight-year-old boy presented with left eye pain, photophobia, proptosis, third nerve paresis and decreased visual acuity. Magnetic resonance imaging revealed a nonenhancing mass filling the cavernous sinus. Using an extradural fronto-orbitozygomatic approach, the cavernous sinus was approached laterally, and a teratoma was removed from within the cavernous sinus. This is the first case of a truly intracavernous teratoma in a child and the fourth case of a teratoma reported in the cavernous sinus region overall. This report outlines the diagnosis and treatment of this unusual cavernous sinus tumor.
Low-Pressure Shunt ‘Malfunction’ following Lumbar Puncture in Children with Shunted Obstructive Hydrocephalus
Authors: Dias Mark S. , Li Veetai , Pollina John
Published: April 2003

Most shunt malfunctions present with signs and symptoms of high intracranial pressure, and computed tomography scans demonstrate ventricular enlargement. However, several authors have described a rare ‘low-pressure’ hydrocephalic state in which ventricular enlargement can occur in the face of low, or even negative, intracranial pressures. We report 2 children with obstructive hydrocephalus in whom this ‘low-pressure state’ followed a lumbar puncture; in both children, the shunts were functioning properly despite increased ventricular size on computed tomography scans, and all symptoms resolved (and the ventricles returned to baseline) following a period of enforced recumbency without shunt revision. We hypothesize that subarachnoid cerebrospinal fluid leakage through the puncture site in the lumbar theca decreases the intracranial pressures globally to a point below the opening pressures of the shunt valves. The ventricular cerebrospinal fluid, unable to be drained through either the subarachnoid space or the shunt, accumulates within the ventricular system under low pressure. One consistent feature in our 2 patients has been the postural nature of the headaches. We recommend enforced recumbency and, if necessary, a blood patch to seal the lumbar leakage. Shunt revision or prolonged external ventricular drainage appears to be unnecessary in these patients. Finally, neurosurgeons should be aware of this potential complication.
Embolization of a Giant Torcular Dural Arteriovenous Fistula in a Neonate
Authors: Liu Hon-Man , Kuo Meng-Fai , Tu Yong-Kwang
Published: April 2003

We treated a neonatal infant who presented with heart failure and a giant torcular dural arteriovenous fistula by staged transtorcular embolization with two guidewires, 95 platinum microcoils, and tissue glues through a needle-size craniotomy. Blood loss was minimal. The patient was stable without heart failure after a three-staged embolization. The lesion disappeared on the follow-up angiography done at the age of 3 years. This is the first documented case of neonatal giant torcular dural arteriovenous malformation cured by interventional neuroradiology. The dilemma and strategy in managing this patient will be presented and discussed.
Infundibuloneurohypophysitis in Children
Authors: Atkins Don , Sanford Robert , Thomas Brannon , Joyner Royce
Published: April 2003

Two children with diabetes insipidus secondary to a chronic inflammatory infiltrate of the infundibulum – infundibuloneurohypophysitis – are presented. Features unique to these cases are contrasted with prior case reports. The differential diagnoses of diabetes insipidus and inflammatory pituitary disorders are discussed. Recommendations for diagnosis and treatment are proposed.
Tumor Volume and Growth Kinetics in Hypothalamic-Chiasmatic Pediatric Low Grade Gliomas
Authors: Lazareff Jorge A. , Suwinski Rafal , De Rosa Roberto , Olmstead Charles E.
Published: April 2003

Pediatric low grade gliomas evidence a tendency towards quiescent growth, thus complicating the clinical management of nonresected tumors whose clinical behavior may be difficult to predict. We decided to explore the hypothesis of possible correlation in pediatric low grade glioma between tumor volume and growth rate. We identified 6 children with hypothalamic chiasmatic lesions. Five of these patients were treated only with biopsy and 1 with repeated partial tumor resection. All of 6 patients had 10–15 sequential brain MRI over a time span of 3–8 years. Tumor volume was determined using Sigma Scan Image® software. The results were analyzed utilizing two equations for modeling tumor growth: exponential and Gompertz. In 4 patients whose tumor volume was approximately 80–100 cm3 at the time of diagnosis, slow spontaneous partial regression was observed. In the other patients deceleratory or exponential tumor growth was volume-dependent. Our results suggest that growth of pediatric low grade glioma decelerates as tumor becomes large and that the Gompertz model for tumor growth is useful for understanding the growth kinetics of pediatric low grade glioma.
Ruptured Arteriovenous Malformation in a Boy with Beckwith-Wiedemann Syndrome
Authors: Yamada Kazumichi , Miura Masaki , Ikeda Tetsuo , Miyayama Haruhiko , Ushio Yukitaka
Published: April 2003

We report here the first case of ruptured arteriovenous malformation (AVM) in a patient with Beckwith-Wiedemann syndrome (BWS). The subject was a 9-year-old boy exhibiting various abnormal features characteristic of BWS, who had undergone frequent surgical management for conditions such as umbilical hernia, polydactyly, inguinal hernia, cleft palate and lip, and undescended testis. The patient was suffering from ruptured AVM in the right frontal lobe, which was successfully managed with surgical interventions. The possible genetic mechanisms that formed the cerebral vascular malformations in this patient are discussed.
Aneurysmal Bone Cyst of the Temporal Bone
Authors: Lippman Caleb R. , Jallo George I. , Feghali Joseph G. , Jimenez Elpidio , Epstein Fred
Published: April 2003

Objective and Importance: Aneurysmal bone cysts (ABC) are benign bone neoplasms which typically involve the spine and long bones. We present a rare case of an ABC in the temporal bone with significant cerebellar compression. Clinical Presentation: The patient was a young boy who presented with several weeks of left posterior auricular pain. Computed tomography, magnetic resonance imaging and angiogram showed an expansile bone neoplasm involving the left petrous temporal bone. Intervention: A retrosigmoid-transmastoid craniectomy was performed, and total removal of the bone lesion was achieved. The pathological examination revealed the diagnosis of ABC. Conclusion: The postoperative course was uneventful, and the imaging studies demonstrated total removal of the neoplasm. This case represents the imaging and surgical management of a rare ABC in the temporal bone. This diagnosis should be considered in the differential of bone neoplasms in this region.
Experiences with Cranial Neuronavigation in Pediatric Neurosurgery
Authors: Wagner W. , Gaab M.R. , Schroeder H.W.S. , Sehl U. , Tschiltschke W.
Published: April 2003

Frameless, infrared-based neuronavigation (Surgical Microscope Navigator® and Surgical Tool Navigator®) was applied to intracranial neurosurgery in 22 children and infants (age range 7 months to 16 years). Predominant diagnoses were tumor and hydrocephalus (including multiloculated forms); the surgical procedures were open microneurosurgery in 10 cases and neuroendoscopy in 12 patients. There were no principal technical problems even in very young infants. Surgical and clinical results were satisfying in all cases. Neuronavigation proved to be particularly helpful in targeting deep-seated processes and in guiding neuroendoscopy in cases of multiloculated hydrocephalus or small ventricles.
The Endocrine Spectrum of Arachnoid Cysts in Childhood
Authors: Mohn A. , Schoof E. , Fahlbusch R. , Wenzel D. , Dörr H.G.
Published: April 2003

Background: On clinical grounds, arachnoid cysts are usually associated with neurological dysfunction. There is little information concerning their involvement in endocrinological disorders. Patients: The experience in 6 children (birth to 12 years) with hypothalamic-pituitary disturbances secondary to the presence of intracranial arachnoid cysts is reported and the literature is reviewed. Results: Three of our children were diagnosed with isolated hormone abnormalities (2 children with precocious puberty and 1 child with growth hormone, GH deficiency). One child presented the unusual combination of GH deficiency and precocious puberty. The remaining 2 children developed panhypopituitarism associated with diabetes insipidus. Conclusion: Arachnoid cysts may cause a wide spectrum of endocrinological disorders. Periodical and complete follow-up of every patient is recommended.
Virtual Endoscopy for Planning Endoscopic Third Ventriculostomy Procedures
Authors: Burtscher J. , Dessl A. , Bale R. , Eisner W. , Auer A. , Twerdy K. , Felber S.
Published: April 2003

Virtual endoscopy was used to plan 10 endoscopic third ventriculostomy procedures in 9 patients suffering from occlusive hydrocephalus due to idiopathic aqueductal stenosis and tumors. The patients were 4 children (4–14 years, mean age: 9 years) and 5 adults (21–38 years, mean age: 29 years). The aim of the study was to preoperatively evaluate the individual intraventricular and vascular endoscopic anatomy at the floor of the third ventricle based on virtual endoscopic images. The virtual views were correlated with the real endoscopic images, intraoperatively obtained by a standard ventriculoscope (Wolf, Knittlingen, Germany) during endoscopic third ventriculostomy procedures. Contrast-medium-enhanced MR images (3D-MPRAGE; Siemens, Germany) were semiautomatically segmented with a surface-rendering technique (‘Navigator’ software; General Electric Medical, Buc, France) to produce the virtual endoluminal views. The virtual endoscopic images were comparable with the real intraoperative endoscopic view in 8 of 9 patients. Virtual endoscopy can display the position of the basilar artery, the posterior cerebral arteries and the posterior communicating arteries in their relationship to the mammillary bodies and the clivus. Preoperative virtual endoscopy planning can intraoperatively assist the neurosurgeon to find a safe location for third ventriculostomy.
Terminal Myelocystocele: An Unusual Presentation
Authors: Cartmill M. , Jaspan T. , Punt J.
Published: April 2003

Terminal myelocystocele is an unusual form of occult spinal dysraphism. It consists of a cystic dilatation of a low-lying terminal cord herniated posteriorly through a skin-covered lumbosacral spina bifida. An arachnoid-lined meningocele, continuous with the spinal subarachnoid space, is traversed by the hydromyelic cord. Clinically, this presents with a skin-covered lumbosacral mass, but often no neurological deficit is present. We present a case of terminal myelocystocele in a child born without deficit and without an obvious back mass. Diagnosis was delayed until sphincter disturbance and lower limb inequalities developed. We discuss the presentation, imaging and operative findings in this case.
Cyst Wall Enhancement in Pilocytic Astrocytoma: Neoplastic or Reactive Phenomena
Authors: Beni-Adani Liana , Gomori Moshe , Spektor Sergei , Constantini Shlomi
Published: April 2003

Cystic pilocytic astrocytomas (CPA) consist of a mural nodule and an accompanying cyst, which may prominently enhance on MRI after contrast administration. This raises the question whether an enhanced wall represents a tumor and thus should be resected together with the solid nodule, as radical tumor surgery is associated with better prognosis. Until now, no systematic histopathological examinations of cyst walls have been reported in correlation with MRI, intraoperative appearance and postoperative clinical and MRI follow-up. We present 3 patients with CPAs and brightly enhanced cyst walls on MRI. Because of the benign, transparent appearance of the cyst wall intraoperatively, it was biopsied but not resected, and only radical removal of the nodule and its immediate surroundings was performed. Separate specimens taken from the cyst wall showed no tumor. MRI performed annually, up to 48–56 months after surgery showed no recurrence of the cyst or the tumor. In such cases of CPA, we suggest that enhancement of cyst walls may represent reactive rather than tumoral tissue, and may be left intact without risking worse prognosis. Mechanisms leading to cyst wall enhancement and the optimal surgical treatment are discussed.
Benign Melanocytic Tumor in Infancy: Discussion on a Rare Case and Review of the Literature
Authors: Oruckaptan H. Hakan , Soylemezoglu Figen , Kutluk Tezer , Akalan Nejat
Published: April 2003

Meningeal melanocytoma is an infrequent neoplasm of the central nervous system (CNS), especially in childhood and infancy. It was first described as an entity different from pigmented meningiomas and schwannomas in 1972, and few cases have been published so far. In this article, a 5-month-old male patient with meningeal melanocytoma is presented. This midline lesion was localized in the posterior fossa and manifested by hydrocephalus. The entire dural origin and extradural growing pattern in addition to the destruction of the adjacent occipital bone were the unexpected presentations since these tumors usually tend to locate on leptomeninges and to extend into the adjacent neural compartment rather than the outside. On the other hand, this case is the only one which had identical lesions in both surrenal glands and the left renal capsule, the structures containing neural-crest-derived cells outside the CNS. The prognostic criteria, differential diagnosis and its embryological aspects are discussed with an extensive review of the related existing literature.
Recovery of Intellectual Ability following Traumatic Brain Injury in Childhood: Impact of Injury Severity and Age at Injury
Authors: Anderson Vicki , Catroppa Cathy , Morse Sue , Haritou Flora , Rosenfeld Jeffrey
Published: April 2003

Traumatic brain injury (TBI) may have a profound impact on a child’s ongoing development. Various risk factors have been found to predict outcome, but considerable variability remains unexplained. This study used a prospective, longitudinal design to examine the relationship between recovery, injury severity, age at injury and pre-injury ability. 124 children were divided according to (1) age at injury: ‘young’ (3–7 years) ‘old’ (8–12) and (2) injury severity (mild, moderate, severe). Children were evaluated acutely (T1) and at 12 months post-injury (T2), using standardized intellectual measures (IQ). Results showed a relationship between greater injury severity and poorer IQ. Age at injury was not predictive of outcome for children with mild/moderate TBI. For severe TBI, younger age at injury led to minimal recovery in IQ, while recovery from later injury was similar to that for adults. Findings suggest that children sustaining severe TBI in early childhood may be particularly at risk for residual problems post-injury.
An Unusual Case of Traumatic Intracranial Hemorrhage Caused by Wakeboarding
Authors: Chia J.K.K. , Goh K.Y.C. , Chan Chumpon
Published: April 2003

Wakeboarding is a relatively new and exciting sporting activity which is similar to water-skiing. While there have been several reports of water-skiing-related injuries, there has been nothing reported in the literature so far concerning injuries in wakeboarding. We present the case of a 14-year-old male who sustained an unusual intracranial subdural hemorrhage while wakeboarding and postulate on the mechanisms which could have resulted in the injury.
Prolonged Cerebral Salt Wasting Syndrome Associated with the Intraventricular Dissemination of Brain Tumors
Authors: Oruckaptan H. Hakan , Ozisik Pınar , Akalan Nejat
Published: April 2003

Hyponatremia is a frequent event in neurosurgery practice and is usually associated with subarachnoid hemorrhage, head trauma, infections and neoplasms. The two common clinical manifestations are the inappropriate secretion of antidiuretic hormone (SIADH) and the cerebral salt wasting syndrome (CSWS), which were usually attributed to each other due to identical clinical presentation. In contrast to the better-recognized SIADH, there has not been a uniform consensus over the humoral and neural mechanisms of CSWS and functional aspects of renal response. In this article, we report on 2 cases of a primitive neuroectodermal tumor with prolonged CSWS manifested during the intraventricular dissemination of primary disease and the high catabolic stage.
Cerebral Aspergillosis in Children
Authors: Cuccia Vicente , Galarza Marcelo , Monges Jorge
Published: April 2003

Between March and December of 1997, 3 cases of infantile cerebral aspergillosis appeared in our hospital. All patients presented some kind of immunosuppression associated with clinical findings of intracranial hypertension. After surgery, all cases were histopathologically confirmed and had positive cultures of Aspergillus. The first case was a patient with a history of subtotal resection of supratentorial ependymoma which presented a new enhancing mass on a control CT scan. Brain tumor recidiva was suspected, although, an Aspergillus granuloma was encountered on the tumor bed. Both other cases were found in patients who underwent transplantation: one presented multiple cerebral lesions after a renal transplant, and the other, after a bone marrow transplant, developed a rhinocerebral aspergillosis. The discussion was focused on the clinical findings, images and treatment of this cerebral infectious disease.
Duplication of the Hypophysis
Authors: Burke Michael , Zinkovsky Sophia , Abrantes Maria-A. , Riley William
Published: April 2003

The authors describe an 11-year-old girl with duplication of a pituitary gland and hypertelorism. Of the 14 cases described to date, only 2 others have lacked associated major facial or oral anomalies. Two separate glands, respective stalks and hypothalamic enlargement were incidentally found on MR imaging performed to evaluate the patient’s complaint of anosmia. A tortuous fusiform dilatation of one pericallosal artery was also discovered. A review of hypophyseal embryogenesis is presented. It is now evident that duplication of the pituitary can occur without other major dysmorphias. This may infer that notochord/prochordal plate deficits are not a prerequisite for hypophyseal duplication.
Belief in Transmigration of the Soul and Psychopathology in Israeli Druze
Authors: Iancu Iulian , Spivak Baruch , Mester Roberto , Weizman Abraham
Published: April 2003

One of the central tenets of the Druze religion is the transmigration of the soul. In rare cases this belief may be related to psychopathology or cause a temporary inability to function normally. We report on 5 Druze patients whose preoccupation with transmigration was the basis of their pathological behavior. These cases illustrate the interaction between cultural and religious beliefs, and psychopathology, and emphasize the importance of employing a culture-specific psychiatric approach in the management of this type of patients.
Psychopathological Considerations on the Relationship between Bulimia and Obsessive-Compulsive Disorder
Authors: Aragona, Massimiliano , Vella Gaspare
Published: April 2003

The relationship between eating disorders, impulse control disorders and obsessive-compulsive disorder as part of a so-called ‘obsessive-compulsive spectrum’ is discussed, with particular emphasis on the relationship between eating disorders (particularly bulimia) and obsessive-compulsive disorder. The empirical studies on comorbidity, personality and familiarity are briefly reviewed. Both similarities and differences found in personality, body image, mental rumination, fears, physical exercises, rituals, impulses (bulimic binging and obsessive impulses) and purging behaviors of these patients are discussed from a psychopathological point of view. In particular the importance of distinguishing between obsessive thoughts and prevalent (dominant) thoughts is underlined; the distinctions between repetitive weight controls, physical exercises and purging behaviors of eating disorder patients on the one hand and compulsions on the other, and the distinction between binge impulses and obsessive impulses, are also stressed.
Religious Faith after Psychotic Illness
Authors: Kirov George , Kemp Roisin , Kirov Kiril , David Anthony S.
Published: April 2003

Religion can play an important role in the lives of psychiatric patients. We assessed how often a psychotic illness can lead to a change in the strength of religious faith and how commonly religion is used for coping with such illnesses in a sample of consecutively admitted patients. 52 patients with psychosis were interviewed regarding their religious beliefs after their index admission. 69.4% of the patients were religious, and 11 (22.4%) stated that religion was the most important part of their lives. 30.4% of the sample described that there had been an increase in their religiousness after the onset of illness. 61.2% of patients were using their religion for coping with the illness. Such patients had a better insight into their illness and were more compliant with antipsychotic medication. We conclude that the experience of a psychotic illness is likely to lead to an increase in religious beliefs. Such beliefs are commonly used for coping with the illness and some patients attach a great importance to them.
Sampling Biases in a Marital Study on Severe Major Depression
Authors: Marin A. , Backenstrass M. , Fiedler P. , Mundt Ch.
Published: April 2003

A comparison was carried out between participants and refusers to participate in a 2-year prospective follow-up study of major depression. 88 consecutively admitted patients of the Psychiatric University Hospital Heidelberg had been addressed. All of them fulfilled both the ICD-9 criteria for Endogenous Depression and the DSM-III-R criteria for Major Depression according to SCID. 38 patients declined participation. Participants and refusers were compared with regard to 56 items of psychopathological symptomatology, socio-demographic data, quality of marital relationship, and personality features. The information about these items was taken systematically from the medical records both of participants and refusers. For some items methods of content analysis were applied to the case histories. Only few differences between participants and refusers were found. Women and more severely ill patients were less willing to accept participation. The degree of marital problems did not differentiate between consenters and refusers.
Memory Bias for Panic-Related Material in Patients with Panic Disorder
Authors: Neidhardt Eva , Florin Irmela
Published: April 2003

Two experiments investigated memory bias for panic-related material in 40 patients with panic disorder and 40 healthy control subjects. No memory bias was found on a memory task that tested intentional encoding and explicit recall of panic-related versus non-panic-related sentences. In contrast, a significant memory bias was apparent on a memory task requiring classification of panic-related and non-panic-related words to test conceptual information processing in implicit memory. Panic patients learned panic-related material better than controls.
Psychiatric Comorbidity in Greek Patients with Generalized Anxiety Disorder
Authors: Garyfallos George , Adamopoulou Aravela , Karastergiou Anastasia , Voikli Maki , Milis Vasilis , Donias Stamatis , Giouzepas John , Parashos Andreas
Published: April 2003

From a total sample of 1,448 psychiatric outpatients, 81 (5.6%) received a diagnosis of generalized anxiety disorder (GAD) according to DSM-III-R criteria. Fifty-three (65%) of them had another Axis I diagnosis, while this percentage increased to 78% (63/81) when lifetime psychiatric diagnoses were recorded. The most frequent comorbid diagnoses were panic disorder, dysthymia, major depression and social phobia. Forty-three (53%) of the GAD patients met the criteria for personality disorder. They manifested obsessive-compulsive, avoidant personality and personalities of cluster C in general significantly more frequently than the rest of the total sample. The presence of a personality disorder was related to a significantly higher score on almost all the Minnesota Multiphasic Personality Inventory clinical and research scales, to a worse level of functioning and to an earlier age of onset of GAD. The results of the present study (1) support previous findings of high rates of comorbidity of clinical syndromes in GAD, (2) indicate that GAD co-occurs frequently with cluster C personality disorders, mainly avoidant and obsessive-compulsive, and (3) that the presence of a concomitant personality disorder is related to severer psychopathology and to a worse level of functioning.
Extended Suicide Attempt: Psychopathology, Personality and Risk Factors
Authors: Meszaros Kurt , Fischer-Danzinger Doris
Published: April 2003

Delinquency among depressed patients plays a minor role in criminal behavior. Among the most tragic associations between depression and criminality are cases of extended suicide or suicide attempt. We studied psychopathology, personality, and psychosocial stressors of 9 Austrian females who committed a serious extended suicide attempt. They were admitted for treatment at a special department of the Justizanstalt Wien-Josefstadt, Aussenstelle Wilhelmshöhe. Patients were diagnosed according to ICD-10 as severely depressed with (n = 6) or without (n = 3) psychotic features. After stabilization we diagnosed the following personality disorders: anxious-avoidant (n = 5), paranoid (n = 1), combined (n = 1) and borderline type (n = 1). Traits of the typus melancholicus were found in 5 patients. Seven females were pretreated before the offence by a psychiatrist or a psychologist; 4 of them had committed at least one suicide attempt in the past. Main psychosocial stressors mentioned by patients in the context of the offence were overstrain, marital and/or financial problems. One female killed her child under the influence of acoustic hallucinations. Patients with traits of the melancholic type showed an altruistic and hypernomic motive for killing as well as a psychotic identification with the victim, whereas in the other cases egocentric motives were in the forefront. Potential risk factors for an extended suicide attempt will be discussed.
Psychopathology and Wisconsin Card Sorting Test Performance in Young Unmedicated Schizophrenic Patients
Authors: Parellada E. , Catarineu S. , Catafau A. , Bernardo M. , Lomeña F.
Published: April 2003

The relationship between psychopathology and Wisconsin Card Sorting Test (WCST) performance was evaluated in 25 unmedicated young acute schizophrenic female patients (14 neuroleptic-naive and 11 neuroleptic-free) and 15 female controls. The schizophrenic patients (especially the neuroleptic-free) performed more poorly than controls in the WCST. In addition, WCST impairment correlated with both negative and positive symptoms. The results suggest that the neuropsychological dysfunction in schizophrenia is present at the onset of the illness, and is neither secondary to previous neuroleptic treatment nor to chronicity of the illness.
The Complexity of Psychiatric Comorbidity: A Conceptual and Methodological Discussion
Authors: Vella Gaspare , Aragona Massimiliano , Alliani Daniela
Published: April 2003

Comorbidity is widely used in psychiatry, although few studies have considered the conceptual and methodological problems deriving from the transposition of this term from medicine to psychiatry. Comorbidity should be defined as two or more diseases, with distinct aetiopathogenesis (or, if the aetiology is unknown, with distinct pathophysiology of organ or system), that are present in the same individual in a defined period of time. In psychiatry, comorbidity is often an artefact for several reasons: (a) different assessment methods; (b) improper utilisation of the term comorbidity to indicate the association of symptoms instead of diseases; (c) number and characteristics of hierarchical exclusion rules used in classification systems; (d) nosologic classification in disorders (a generic term) instead of syndromes (a more precise concept, that allows clinicians to consider the hierarchy and the qualitative specificity of symptoms); (e) excessive splitting of classical syndromes into small disorders with inappropriate and overlapping boundaries; (f) too frequent revision of the diagnostic criteria, that changes diagnostic threshold; (g) number of clinical entities considered. Biological and psychological hypotheses that investigate the complexity of comorbidity findings are here presented; it is underlined that comorbidity should be the epidemiological descriptive starting point to build hypotheses that must be clear and rigorously defined, with specified usefulness and limits. Finally, the hypotheses should be tested with specific methodologies.
Temperament, Character and Perceived Parental Rearing in Healthy Adults: Two Related Concepts?
Authors: Richter Jörg , Eisemann Martin , Richter Gabriele
Published: April 2003

The goal of this study was to test for relationships between personality according to Cloninger’s Temperament and Character Inventory (TCI) and perceived parental rearing under consideration of cognitive distortions as confounding variables. Five hundred and forty healthy volunteers completed the TCI, the EMBU questionnaire (assessing perceived parental rearing), and the Dysfunctional Attitude Scale. The data were subjected to Pearson correlations, partial correlations, multiple regression, and factor analyses. Gender-specific relationships were found between parental rearing and both the temperament and the character dimensions. The factor structure of the TCI remained unchanged irrespective of the inclusion of the parental rearing factors. Since environmental factors (e.g., parental rearing) influence both temperament (supposed to be genetically determined) and character dimensions, the focus should be on the interaction between both aspects through the life span.
Relationships between Subjective Experiences of Deficit and Other Psychopathological Features in Schizophrenia
Authors: Yon V. , Loas G.
Published: April 2003

The study of subjective symptomatology among schizophrenic patients has been neglected. Even if the patient complaints have always been at the root of the psychiatrist’s work, it has not been conceivable to integrate them in objective studies. Since 1950, Huber has been interested in the basic symptoms and has developed his concept of ‘a pure defect state’, a syndrome which is present as soon as the beginning of the disease and on which episodes of decompensation would crop up. In the 1980s, a majority of the scales for the assessment of subjective complaints appeared. Our study used the French version of the Scale of Subjective Experiences of Deficit, a scale which has a good internal consistency and interrater and test-retest reliability. In this study of 50 longterm schizophrenic patients, we compare subjective symptoms and objective symptoms using the Positive and Negative Syndrome Scale. We point out – in agreement with previous work – a statistically significant correlation between subjective symptoms and positive symptoms.
Dante’s Inferno: Phenomenology of a Strange Passion
Authors: De Monticelli Roberta
Published: April 2003

Dante’s Inferno presents us with a spiritual adventure where the experience of wrath plays a crucial role. The infernal pilgrim’s ‘passage through wrath’ is their only access to the lower part of Hell. Wrath – and the place where it is punished as a vice – occupy a very central position in the moral topography of Dante’s Inferno: the Stygian Marsh, which defends the heart of Hell, its stronghold, and makes it inaccessible. Wrathfulness is situated at the borderline between ‘carnal’ and ‘spiritual’ sins, higher and lower Hell, weakness and wickedness of the will. What is the meaning of this situation? How is the sin of wrathfulness related to wrath as an expression of just indignation? How can the same passion have an angelical and an infernal face? What is anger’s relation to reason? Does the trial gone through by the two pilgrims teach us something on the nature of this passion? Here are some questions which this paper tries to answer, thereby outlining a phenomenological theory of those passions which might be called ‘dynamic’.
Dysphoria: A Key for ‘Understanding’ Delusion?
Authors: Ballerini Arnaldo , Ballerini Andrea Carlo
Published: April 2003

The ‘nonunderstandability’ that traditional psychopathology attributes to ‘true’ delusion does not have a clear demarcation line, but, rather, it is a continuum of various delusional experiences. The attention paid to emotional situations and, specifically, to dysphoria, often contributes to making the delusional phenomenon, and, above all, its persistence, more understandable. A positive correlation between productive psychotic symptoms and the dysphoric mood often prevails in delusions with unfavorable prognoses.
Schizophrenia and Common Sense: Study of 3 Single Cases
Authors: Naudin Jean , Azorin Jean-Michel , Mishara Aaron L. , Wiggins Osborne P. , Schwartz Michael-Alan
Published: April 2003

There is new interest in subjective experiences of schizophrenia. This kind of analysis emphasizes the subjective stories of patients, and the methods do not pretend to have the objectivity of science. However, the plausibility and the empathetic resonance of the single case may bring subjective confirmation to the validity of an insight and indicate new directions of research. Following this line, the authors present a study of 3 single cases of ‘reflexive’ residual type of schizophrenia. The methods for selecting the cases and the philosophical groundings of the concept of ‘reflexive schizophrenia’ are explained. The analysis of the single cases revealed that (1) schizophrenic persons’ cognitive deficit is related to the constitution of common sense; (2) some schizophrenics cope with the cognitive deficit by creating a theoretical corpus of axioms stemming from common sense, namely the ‘axioms of everyday life’; (3) this mechanism of coping is described as an inflexible attachment to ‘axioms of everydayness’, and (4) this attachment to common sense releases the patient from all personal investment of self in the process of anchoring in the living world and, on this basis, allows a relatively solid, although distant, attachment to reality. The nature of deficit in schizophrenia is also discussed by confronting the phenomenological point of view and the neuropsychological, that is the so-called ‘theory of mind’.
Life Crisis and the Body within
Authors: Lorenzi Primo , Hardoy Maria Carolina , Cabras Pier Luigi
Published: April 2003

The authors take into account body involvement during the existential critical periods. The concept of body involvement considers both the biological (organic) involvement of the body, i.e. all the ‘psychosomatic’ (in a wider sense) dimensions, and the involvement of the mental representation of one’s body. This involvement refers to some clinical conditions as ‘abnormal somatic styles of existence’, hypochondriasis and dysmorphophobia (all grouping in the DSM-IV ‘somatoform disorders’) and the anorexic states. From a structural psychogenetic point of view, this firm involvement of the body (naturally we are referring to the ‘experienced body’) is stressed in light of its importance in self identity construction and maintenance, especially when, as in some existential critical periods, identity physiologically faces significant modifications and hazardous movements.
Influence of Asthma in Pregnancy on Labor and the Newborn
Authors: Minerbi-Codish Iris , Fraser Drora , Avnun Lone , Glezerman Marek , Heimer Dov
Published: April 2003

Asthma in pregnancy has been associated with maternal and fetal morbidity and mortality. This study examines the relations of asthma in pregnancy, its severity and its treatment to the labor process, maternal and fetal parameters. Hundred and one consecutive asthmatic women, who gave birth to single babies between November 1993 and November 1994 at the Soroka Medical Center were studied. A group of 77 nonasthmatic women, matched for age and ethnic origin, who gave birth to single babies during the same period served as controls. A larger percentage of asthmatic women suffered from respiratory and urinary tract infections than in the control group (p < 0.001). Severe asthma was associated with a higher rate of infections than milder asthma (p = 0.01). The incidence of smoking was higher among asthmatic women than among controls (p = 0.037). No association was found between socioeconomic status and smoking or infections. No association was found between maternal asthma or maternal use of corticosteroids and the following: maternal hypertension, maternal diabetes, low birth weight (<2,500 g), preterm delivery (<37 weeks), adequacy of weight to gestational age and Apgar scores. Three infants with congenital heart defects were born to asthmatic mothers. When the presentation of the fetus was not cephalic, all the asthmatic women were delivered by cesarean section, versus only 60% in the control group (p = 0.08). Labor was induced with oxytocin more often in the asthma group than in the control group (p = 0.07). We conclude that the labor and neonatal outcome in pregnant asthmatic women treated medically is good, even when asthma is severe and when the patient is treated with corticosteroids. There is, however, a relation between asthma in pregnancy, especially if severe, and predisposition to infections.
Diagnostic Tools in Tuberculosis
Authors: Salfinger Max , Hale Yvonne M. , Driscoll Jeffrey R.
Published: April 2003

Leadership will play a major role in the management of tuberculosis in the future. Many populations, such as immunocompromised patients and immigrants from countries with a higher prevalence of tuberculosis, create a challenge for care and diagnosis. Mycobacterial laboratory testing has undergone many changes in the past 10 years with the advent of nucleic acid probes for identification of Mycobacterium tuberculosis, and more recently nucleic acid amplification and beyond where computer technology meets molecular biology. In the past, changes for tuberculosis testing were not incorporated rapidly, sometimes taking 20 years or more to be fully implemented. The dynamics of acceptance of change and more rapid implementation need to be understood. With the use of such programs as Fast Track for Tuberculosis Testing, this can be accomplished more readily. New technologies can be provided to all users of such a network within a short amount of time and health care providers can equally benefit from this novel approach. The tuberculosis laboratory cannot stand alone. It must work together with other players, in order to eliminate tuberculosis.
High-Resolution Computed Tomography of Bronchiolitis Obliterans Syndrome after Bone Marrow Transplantation
Authors: Ooi G.C. , Peh W.C.G. , Ip M.
Published: April 2003

High-resolution computed tomography (HRCT) has been described to be useful in assessing bronchiolitis obliterans (BO) syndrome in the transplanted lung. Currently, BO syndrome is diagnosed if lung function deterioration shows persistent or progressive irreversible airflow obstruction, with FEV1 of less than 80% of baseline values, without clinical evidence of infection. The aim of this study is to assess the value of HRCT in evaluating BO syndrome after allogenic bone marrow transplantation (BMT). Fourteen HRCT scans were performed in 6 women and 3 men with moderately severe irreversible airflow obstruction and a clinical diagnosis of BO syndrome after BMT. Two patients had normal HRCT scans. In the remaining 7 patients, 7 of 11 HRCT scans were abnormal, with non-specific findings of bronchial dilatation (1), consolidation (2), hypoattenuated areas (4) and vascular attenuation (4). In comparison with the consistency of positive HRCT findings of BO syndrome in transplanted lungs, HRCT surveillance for BO syndrome in post-BMT patients with clinically established disease is of limited value, unless other pulmonary complications such as opportunistic infections are to be excluded.