bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Sites of Distant Metastases from Head and Neck Cancer
Authors: Ferlito Alfio , Shaha Ashok R. , Silver Carl E. , Rinaldo Alessandra , Mondin Vanni
Published: April 2003

The incidence of distant metastases in head and neck squamous cell carcinoma (SCC) is relatively small in comparison to other malignancies. Distant metastases adversely impact survival and may significantly affect treatment planning. The incidence of distant metastases is influenced by location of the primary tumor, initial T and N stage of the neoplasm, and the presence or absence of regional control above the clavicle. Patients with advanced nodal disease have a high incidence of distant metastases, particularly in the presence of jugular vein invasion or extensive soft tissue disease in the neck. Primary tumors of advanced T stages in the hypopharynx, oropharynx and oral cavity are associated with the highest incidence of distant metastases. Pulmonary metastases are the most frequent in SCC, accounting for 66% of distant metastases. It may be difficult to distinguish pulmonary metastasis from a new primary tumor, particularly if solitary. Other metastatic sites include bone (22%), liver (10%), skin, mediastinum and bone marrow. An important question remains as to how intensely pre- and postoperative screening for distant metastases should be performed. Preoperative chest X-ray is warranted in all cases. If the primary tumor and nodal status place the patient at high risk for pulmonary metastasis, then preoperative computed tomography scan of the chest should be done. Screening for distant metastases at other sites is usually not indicated in SCC of the upper aerodigestive tract. Postoperatively, annual X-rays of the chest are usually sufficient, but in high-risk situations a chest X-ray performed every 3–6 months may be beneficial. Certain histologic types of primary tumor have greater or lesser propensity to metastasize distantly, and have a different natural history. Adenoid cystic carcinoma metastasizes frequently, even in the absence of extensive local or regional disease. Basaloid squamous cell carcinoma and neuroendocrine carcinomas also metastasize widely. Extensive evaluation for distant metastases is justified for these tumors. Knowledge of the natural history of various neoplasms and the factors that contribute to distant metastases as well as good judgement are essential for cost-effective treatment planning and decision-making with regard to pre- and postoperative evaluation for distant metastases in cancer of the head and neck.
Pediatric Occipitocervical Arthrodesis
Authors: Schultz Jr. K.D. , Petronio J. , Haid R.W. , Rodts G.E. , Erwood S.C. , Alexander J. , Naraad C.
Published: April 2003

Object: Few reports exist on the options and effectiveness of craniocervical stabilization in the pediatric population compared with the adult literature. Traditional options in children include onlay grafting and semi-rigid occipitocervical wiring. Recently, reports on the use of rigid internal fixation devices such as occipitocervical plates and contoured loops have provided excellent results in adults, and their use has often obviated the need for external orthosis. The purpose of this article is to report our experience with both traditional and newer rigid internal fixation methods for occipitocervical fusion in children. Methods: During the past 4.5 years, 14 children (ages 4 months to 16 years) have undergone occipitocervical fusion. Indications for fusion included trauma (n = 4), congenital instability/stenosis (n = 6), postinfectious instability (n = 1) and basilar invagination (n = 3). Techniques using onlay grafting (n = 3) as well as rigid internal fixation using plates (n = 1) and contoured craniocervical titanium loops (n = 10) were used. Postoperative orthosis included halo vests (n = 7), minerva jackets (n = 3), sterno-occipital mandibular immobilizer (n = 1), and a cervical collar (n = 3). Long-term follow-up (range 13–58 months) was available for 13 of the 14 children. Conclusions: While each occipitocervical fusion in pediatric patients requires a customized treatment plan, we believe children older than 12 months of age should be considered candidates for rigid internal fixation methods. The rigidity afforded by this method may eliminate the need for rigid external orthotic support in selected individuals. In our experience, anatomic constraints in children less than 1 year old usually require fusion with more traditional onlay techniques. Long-term follow-up studies are still required to assess the effects of rigid internal fixation in the skeletally immature spine.
Hemimegalencephaly and Intractable Epilepsy: Complications of Hemispherectomy and Their Correlations with the Surgical Technique
Authors: Di Rocco Concezio , Iannelli Aldo
Published: April 2003

Hemispherectomy is required in most cases of hemimegalencephaly in order to control epilepsy refractory to medical treatment. Although there is a general agreement on the effectiveness of the procedure in controlling the seizure disorder, the choice of the surgical technique is still a subject of debate. In particular, anatomical hemispherectomy is blamed to be associated with a higher incidence of surgical complications, namely hydrocephalus and hemosiderosis, than other less ablative operations such as functional hemispherectomies. A series of 15 children with hemimegalencephaly, who had undergone anatomical hemispherectomy (11 cases), functional hemispherectomy (2 cases), and hemidecortication (2 cases) at the Pediatric Neurosurgery Section, Catholic University Medical School, Rome, is reported. Twelve of these patients presented with one or more complications in their postoperative course. Temporary complications, which resolved spontaneously or following medical therapy, included fever, wound breakdown, worsening of preoperative motor deficit, unilateral third cranial nerve deficit, dystonia, and anemia. In 8 patients, postoperative complications led to a second surgical procedure. A CSF shunt was necessary in 5 children, to control a secondary hydrocephalus. Two subjects underwent a toilette of the residual cavity because of persisting chemical abnormalities in CSF parameters. In a child a cranioplasty procedure was necessary as a consequence of an infection of the hemicranial bone flap. There was no apparent correlation between the rate and the type of complications with a specific surgical procedure. On the other hand, the age factor appeared to play an important role in the occurrence of secondary hydrocephalus, as all 5 children with this complication were less than 9 months old at the time of the hemispherectomy. Surgical mortality was nil in this series.
Intratumoral Therapy with Bleomycin for Cystic Craniopharyngiomas in Children
Authors: Hader Walter J. , Steinbok Paul , Hukin Juliette , Fryer Chris
Published: April 2003

Surgical removal of cystic craniopharyngiomas in children is associated with significant operative morbidity and recurrence rates. The purpose of this study was to review our experience with a less invasive therapy, namely, intratumoral bleomycin, in the treatment of predominantly cystic craniopharyngiomas. All children with craniopharyngiomas treated at a tertiary care pediatric neurosurgical center since 1994, when bleomycin was first used, were reviewed retrospectively. Seven patients received intratumoral bleomycin therapy. Patients received 2–5 mg bleomycin per dose, 3 times per week, for 3–5 weeks as an initial course. Mean follow-up of these patients was 3 years. In 4 patients, treatment resulted in a significant decrease (>50%) in tumor size, which has remained stable. Two patients’ tumors progressed and underwent resection, and 1 patient had surgical removal because of persistent headaches, although no growth of residual tumor had been noted. One patient developed peritumoral edema as a result of bleomycin therapy. Intratumoral bleomycin is a useful alternative therapy for cystic craniopharyngiomas, and may control tumor growth and delay potentially harmful resection and/or radiotherapy in young children.
Three Choroid Plexus Papillomas in a Patient with Aicardi Syndrome
Authors: Taggard Derek A. , Menezes Arnold H.
Published: April 2003

Aicardi syndrome is an X-linked dominant disorder primarily defined by the triad of corpus callosum agenesis, infantile spasms and a pathognomonic lacunar chorioretinopathy. Papillomas of the choroid plexus have been reported in affected patients. We report an Aicardi syndrome patient who had three separate choroid plexus papillomas and associated hydrocephalus. A dizygotic twin was unaffected. Staged resection of the tumors was safely accomplished, with improvement in seizure control. Imaging between procedures revealed rapid tumor growth.
The Position of the Conus medullaris in Children with a Chiari I Malformation
Authors: Tubbs R. Shane , Elton Scott , Bartolucci Alfred A. , Grabb Paul , Oakes W. Jerry
Published: April 2003

The purpose of this study is to determine whether there is a relationship between the conus level and patients with a Chiari I malformation. This retrospective MRI study evaluated conus levels and degrees of tonsillar ectopia in 26 children ages 5–16 years with a Chiari I malformation. Our results show that there seems to be no relationship between the conus level and the amount of tonsillar ectopia that a child with a Chiari I malformation might have. In fact, there seemed to be an inverse relationship between these two entities. Interestingly, we have also found that of all coni located at the L2–L3 disc space or below, these patients had a syrinx associated with their Chiari I malformation and that all malformations without a syrinx had a ‘normally’ positioned conus medullaris.
An Experimental Animal Model of Split Cord Malformation
Authors: Emura Takaki , Asashima Makoto , Hashizume Kouhei
Published: April 2003

In this study, we examined an experimental animal model of split cord malformation (SCM) produced by the surgical induction of a fistula. In Cynopus pyrrhogaster neurulae (stage 18.5 ± 0.5), the neural plate was incised and divided to construct a fistula that mimicked a neurenteric canal. After the procedure, the development of these embryos was examined morphologically and histologically. Following incubation, hemicords, hemicords with their own heminotochords, and dermal sinus were observed in histological sections of embryos with an induced fistula. These abnormalities varied with the length and duration of the fistula, and the induction of this fistula apparently caused the development of this anomaly. The histological findings resembled the findings in human cases. The results of this study support the hypothesis that SCM may originate from an accessory neurenteric canal.
Arteriovenous Malformation of the Medulla oblongata Supplied by the Anterior Spinal Artery in a Child: Treatment by Microsurgical Obliteration of the Feeding Artery
Authors: Ito Masanori , Yamamoto Takuji , Mishina Hideto , Sonokawa Tadao , Sato Kiyoshi
Published: April 2003

We report a unique case of a 3-year-old boy with a pial arteriovenous malformation (AVM) in the medulla. The patient presented with a subarachnoid hemorrhage. Magnetic resonance (MR) imaging revealed a 3 × 1 cm flow void area in the premedullary cistern that was compressing the medulla posteriorly. Cerebral angiography and MR angiography showed an aneurysm-like vascular pouch that was fed by the anterior spinal artery and had multiple draining veins. The case was diagnosed as a fistula-type AVM. Treatment options consisted of endovascular embolization or open surgery. We used a left far lateral approach to obliterate the anterior spinal artery. Immediately after the clip was applied to the feeding artery, the pouch began to shrink, and the color of the draining veins changed from red to blue. An intraoperative angiography showed that the AVM had disappeared. The patient recovered fully 1 month after surgery. This case was classified as fistula-type AVM, pial arteriovenous fistula (AVF). Microsurgical obliteration of the anterior spinal artery is considered to be the treatment of choice for perimedullary AVF located in the premedullary cistern if the endovascular treatment is not considered to be feasible.
Acute and Subacute Hydrocephalus in a Rat Neonatal Model: Correlation with Functional Injury of Neurotransmitter Systems
Authors: Ishizaki Ryuji , Tashiro Yuzuru , Inomoto Takaaki , Hashimoto Nobuo
Published: April 2003

Object: The evolution and severity of hydrocephalus in animal models varies in the species and mode of induction. This makes comparisons of the physiological system under investigation difficult between models. We noted that injection of kaolin into neonatal rats results in a dichotomous outcome into either an acute or subacute form. We investigated the clinical and functional transmitter system changes to compare these two types of hydrocephalus evolution. Methods: Hydrocephalus was induced in Wistar neonatal rats (within a week after their birth) by intracisternal injection of 0.02 ml volume of 25% kaolin solution under microscopic guidance. The same volume of sterile saline was injected into 12 neonatal rats as control group. The animals were assigned to either the acute or subacute group according to their head size, and sacrificed at 2, 4 and 8 weeks after injection. Biparietal diameter, ventricular size, cholinergic interneurons in the neostriatum and dopaminergic projection neurons in the substantia nigra were analyzed at each stage. Results: Animals affected with the acute type of hydrocephalus had obvious head enlargement, rapid ventricular enlargement, and all died at about 4 weeks. Animals with subacute type had slowly progressive ventricular enlargement, and all survived until 8 weeks. There appeared to be more kaolin ventral to the brainstem in the acute type. The number of cholinergic neostriatal neurons was significantly reduced at 2 and 4 weeks in the acute type, but only at 8 weeks in the subacute type. The number of dopaminergic nigral neurons was decreased at 4 weeks in the acute type, but unaffected in the subacute type. Conclusions: The severity of onset of hydrocephalus in this animal model also correlates with the clinical outcome and changes in functional transmitter systems.
Effect of Fetal Hydrocephalus on the Distribution Patterns of Calcium-Binding Proteins in the Human Occipital Cortex
Authors: Ulfig Norbert , Szabo Arpad , Bohl Jürgen
Published: April 2003

Neuronal pathology in the cerebral cortex (CC) of fetal hydrocephalus brains is quite subtle when applying routine Nissl staining. This study is aimed at investigating alterations of interneurons which can be immunolabelled by antibodies against the calcium-binding proteins calretinin (CR), calbindin (CB) and parvalbumin (PV). The subplate (SP) subjacent to the cortex anlage is included as this transient zone plays a pivotal role in the establishment of cortical connections. Nine occipital lobes from cases of fetal hydrocephalus and 9 controls were categorized according to age: 21–25 weeks of gestation (group 1) and 32–36 weeks (group 2). No differences in the distribution, number and morphology of CR-immunoreactive (ir) neurons are seen when comparing hydrocephalic with control brains of group 1. In severely altered hydrocephalic brains of group 2, the distribution and number of CR-, PV- and CB-ir nerve cells are not altered; however, they appear shrunken and processes are less immunolabelled. In extremely altered tissue PV-, CB-ir neurons cannot be detected, whereas the number of CR-ir somata is not reduced. The data indicate that subpopulations of interneurons of the CC may be differentially damaged. The alterations observed in the SP may implicate a possible impairment of transient neuronal circuitries that are essential for the development of cortical connections. On the whole, these neuronal alterations may account for residual deficits observed after shunting.
Prognostic Factors in Children with Severe Diffuse Brain Injuries: A Study of 74 Patients
Authors: Pillai Shibu , Praharaj S.S. , Mohanty A. , Kolluri V.R. Sastry
Published: April 2003

Severe diffuse brain injury in children has a devastating influence on their physical and psychological development. This retrospective study was undertaken to analyse the factors that influence outcome in children with such injuries. The short-term outcomes (Glasgow outcome score) of 74 children (age ≤15 years) with severe diffuse brain injury and no focal operable mass lesions on CT scan, admitted between 1992 and 1998 at the National Institute of Mental Health and Neurosciences were analysed. The prognostic factors analysed were age, gender, time after injury to admission, nature of injury, highest post-resuscitation Glasgow coma score (GCS), pupillary reaction, horizontal oculocephalic reflex and CT scan findings. The following factors were found to be independent predictors of poor outcome: GCS 3–5 (p < 0.003), absent verbal response (p < 0.001), motor response score of 1–3 (p < 0.001), absent pupillary reaction (p < 0.001), absent oculocephalic reflex (p < 0.001) and presence of traumatic subarachnoid haemorrhage on CT scan (p < 0.002). These independent variables were then subjected to a stepwise logistic regression analysis, and the most important variables for predicting outcome were oculocephalic reflex and GCS, which together correctly predicted unfavourable outcome with a sensitivity of 79% and a specificity of 65%. An early CT scan or a single CT scan did not have any prognostic significance.
The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury
Authors: Chiaretti Antonio , Pezzotti Patrizio , Mestrovic Julije , Piastra Marco , Polidori Giancarlo , Storti Sergio , Velardi Francesco , Di Rocco Concezio
Published: April 2003

Background: Although disseminated intravascular coagulation (DIC) and other hemocoagulative abnormalities are severe complications of head injury, their effect on clinical outcome remains unclear, particularly among children. Objectives: To evaluate the frequency of hemocoagulative abnormalities and their influence on outcome among children with head injury. Study Design: We conducted a prospective observational study among 60 children with head injury, immediately evaluating severity of head injury (Glasgow Coma Scale, GCS); cerebral axial tomography; prothrombin time; activated partial thromboplastin time (aPTT); fibrinogen level; concentration of fibrin-fibrinogen degradation products (FDP), and platelet count. Two months after injury, we applied the Glasgow Outcome Score (GOS). Associations with GOS were evaluated using univariate and multivariate logistic models. Results: Among children with severe head injury, 22.2% (6/27) developed DIC, all of whom died and had shown severe brain edema. Among those with severe head injury yet without DIC, the mortality was only 14.2%. A low GOS was significantly and independently associated with a low GCS, multiple trauma, delayed aPTT, low fibrinogen level, elevated FDP and low platelet count. Brain edema was also associated with a low GOS, though not significantly. Conclusions: In addition to GCS, type of trauma, type of brain lesion and certain coagulation abnormalities are predictors of GOS.
Evaluation of Children for Epilepsy Surgery
Authors: Olson Donald M.
Published: April 2003

There are three main components to the evaluation of children who are candidates for epilepsy surgery: (1) confirmation of the epileptic nature of the seizures, (2) establishing the medical intractability of the child’s epilepsy and (3) localization of the epileptogenic zone. Differentiating epileptic from nonepileptic events requires careful review of the history and the electroencephalogram. Electroencephalographic recording of the habitual seizures usually suffices to confirm the epileptic or nonepileptic nature of the events. Medical intractability is established by assuring that antiepileptic medications appropriate for the child’s particular epilepsy syndrome have been used and have been titrated to maximum tolerance before being deemed ineffective. Confident localization of the epileptogenic zone requires that multiple findings such as behavior during the seizure, ictal and interictal EEG, and cerebral imaging studies provide data that are convergent with respect to a likely area of seizure onset.
Spontaneous Cerebellar Hemorrhage due to a Juvenile Pilocytic Astrocytoma
Authors: Mesiwala Ali H. , Avellino Anthony M. , Roberts Theodore S. , Ellenbogen Richard G.
Published: April 2003

A 13-year-old boy presented to the emergency room with headaches and ataxia. Imaging studies revealed a cerebellar hemorrhage within a posterior fossa tumor. The patient underwent complete resection of this lesion and made a full recovery. Microscopic examination of this lesion revealed a juvenile pilocytic astrocytoma.
Pneumocephalus Secondary to a Neck Stab Wound without Neurologic Injury in a 13-Year-Old Girl
Authors: Bunc Gorazd , Roškar Zdravko , Voršič Matjaž
Published: April 2003

Pneumocephalus is usually caused by injury that damages the brain meninges and thus allows air to enter the intracranial cavity. Our intention was to establish the importance of considering a stab wound in the neck as a possible cause of traumatic pneumocephalus. The paper presents the case of a 13-year-old girl who was accidentally stabbed in the neck with a kitchen knife by her brother. She had no neurological deficit but had developed headaches. An examination showed cerebrospinal fluid leaking from the neck wound and a CT scan revealed the pneumocephalus. Following surgical treatment, the patient’s clinical symptoms regressed. To our knowledge, this case is the first report of the manifestation of pneumocephalus as the result of a neck stab wound in a child; overall, there are only three reported cases of pneumocephalus caused by a neck stab wound.
Intra-Operative MRI-Guided Approaches to the Pediatric Posterior Fossa Tumors
Authors: Lam Cornelius H. , Hall Walter A. , Truwit Charles L. , Liu Haiying
Published: April 2003

Introduction: The posterior fossa in a child poses a considerable challenge to the neurosurgeon. MRI-guided surgery allows for real time interaction between imaging and the neurosurgeon, not permitted by frameless stereotaxy, and with higher resolution than ultrasound or CT. Materials and Methods: The University of Minnesota 1.5 T Phillips interventional MRI was used. From 1997 to 2000, nine posterior fossa intraoperative magnet cases out of eleven were pediatric. The mean age was 6.4 years and the median age 7. Seven midline craniotomies were performed, of which three were re-operations. Two were burr hole placements, one for cyst aspiration and P32 instillation, and the other for tumor biopsy. Results: Two tumors were predominantly in the fourth ventricle, four in the cerebellum, two in the brainstem, and one in the prepontine cystern. Four tumors were juvenile pilocytic astrocytomas, two were anaplastic astrocytomas, and one each was ependymoma, craniopharyngioma cyst, and medulloblastoma. Four patients had complete radiologic resection. Two had maximal resections limited by vital structures. P32 instillation and tumor biopsy were done in a single pass. Follow-up ranged from 3 months to 1.4 years. The cyst that was aspirated and had P32 instillation remains absent. The two mortalities were in the patients with medulloblastoma and anaplastic astrocytoma. There were no intra-operative mortalities. The other patient with anaplastic astrocytoma progressed. The remainder had stable imaging. Conclusion: MRI-guided surgery results in improved resection imaging and real-time needle guidance in tumor operations. Its value could lie in low-grade lesions, where maximal resection is most beneficial.
Effect of Dietary Vitamin E Supplementationon Vascular Reactivity of Thoracic Aorta in Streptozotocin-Diabetic Rats
Authors: Çınar Mehtap G. , Ülker Sibel , Alper Gülinnaz , Evinç Akgün
Published: April 2003

The present study evaluated the effect of dietary vitamin E supplementation (1,000 mg/kg chow) on the alterations in vascular reactivity of streptozotocin-diabetic aorta of Wistar rats. After 12 weeks of treatment, thoracic aortic rings of rats were mounted in organ baths and contractile responses to phenylephrine and 5-hydroxytryptamine and relaxant responses to acetylcholine, calcium ionophore and sodium nitroprusside were assessed. Plasma vitamin E concentration as measured by HPLC was markedly decreased in diabetic rats and increased with dietary vitamin E supplementation. Induction of diabetes significantly impaired endothelium-dependent relaxations to acetylcholine and calcium ionophore in aortic rings, but did not change endothelium-independent relaxation to sodium nitroprusside. Vitamin E significantly improved the impaired endothelium-dependent relaxations, further it decreased the enhanced contractile response to phenylephrine and 5-hydroxytryptamine in diabetic rings. The mechanical denudation of endothelium or the chemical inhibition of endothelium-dependent relaxation with Nω-nitro-L-arginine methyl ester (100 µmol/l) significantly increased phenylephrine contractility in control rings and the rings of diabetic rats treated with vitamin E; such a difference was not observed in diabetic rats fed with normal diet. Liver and lung malondialdehyde concentrations, as an index of lipid peroxidation, were increased in diabetic rats and significantly decreased with vitamin E supplementation. It is concluded that dietary supplementation of vitamin E improved endothelial dysfunction in insulin-dependent model of uncontrolled diabetes, probably decreasing membranal lipid peroxidation.
Ursodeoxycholic Acid Complexation with 2-Hydroxypropyl-β-Cyclodextrin Increases Ursodeoxycholic Acid Biliary Excretion after Single Oral Administration in Rats
Authors: Ventura Paolo , Panini Rossana , Montosi Giuliana , Garuti Cinzia , Vandelli Maria , Brunetti Gabriele , Tauschel Horst-Dietmar , Pietrangelo Antonello , Salvioli Gianfranco
Published: April 2003

Complexation of ursodeoxycholic acid (UDCA) with 2-hydroxypropyl-β-cyclodextrin (HPβCD) improves the water solubility and the dissolution rate of UDCA and may therefore increase its bioavailability. We compared the amount and the rate of biliary excretion of UDCA and biliary lipid secretion after a single oral administration of UDCA in 3 different pharmaceutical formulations [UDCA-HPβCD (‘urso-β-cyclodextrin’), UDCA suspension and UDCA capsule] at 3 different dosages each, in 11 groups (2 control groups) of bile fistula rats. UDCA excretion increased with an increase in dose, biliary UDCA recovery and peak secretion were significantly higher after administration of UDCA-HPβCD than after UDCA in suspension or capsule. This enhancement of biliary excretion may achieve greater UDCA enrichment in the bile acid pool than conventional pharmaceutical UDCA formulations, this giving to UDCA-HPβCD a considerable therapeutical potential.
An Exploratory Study on Obsessive-Compulsive Disorder with and without a Familial Component: Are There Any Phenomenological Differences?
Authors: Albert Umberto , Maina Giuseppe , Ravizza Luigi , Bogetto Filippo
Published: April 2003

Familial studies on obsessive-compulsive disorders (OCD) have suggested that OCD is a heterogeneous condition, with some cases being familial and others being isolated cases in their families. Nevertheless, no studies evaluated whether there are clinical differences between OCD cases with and without a familial component. The current report presents data on the prevalence of OCD in first-degree relatives of OCD probands and compares phenomenological characteristics of familial and non-familial OCD types. The family study and the family history methods were used to estimate the prevalence of OCD in first-degree relatives of 74 OCD probands. A statistical comparison between OCD probands with and without familial loading was performed using Pearson’s χ2 test, Fisher’s exact test, or Student’s t test when appropriate. The rate of OCD was 3.5% in directly interviewed first-degree relatives. Eleven percent of the probands had at least one family member with OCD. There were no differences between the two types of OCD (familial vs. non-familial) except for life events prior to the onset of OCD, which were more common and more severe in non-familial OCD subtypes. In conclusion, our results (1) confirm that there is a familial component in the expression of some forms of OCD and (2) indicate that familial OCD patients are not characterized by peculiar clinical features, but appear to have a lower threshold for precipitating events.
Maternal Expressed Emotion and Metabolic Control of Children and Adolescents with Diabetes mellitus
Authors: Liakopoulou Magda , Alifieraki Tina , Katideniou Antonia , Peppa Moly , Maniati Mary , Tzikas Dimitris , Hibbs Euthymia D. , Dacou-Voutetakis Catherine
Published: April 2003

Background: The objectives of this study of children and adolescents with diabetes were to: (1) examine whether maternal expressed emotion (EE), in the form of critical comments (CC), hostility and emotional overinvolvement (EOI), is related to metabolic control; (2) determine if CC and EOI are separately related to poor metabolic control, and (3) ascertain whether high EE is related to psychopathology in these children. Methods: The Present Episode version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS-P/K-SADS-P) interview was administered to 55 children and adolescents with diabetes and the parental EE instrument, the 5-min speech sample, to 55 mothers. The same instruments were utilized with the 54 controls and their mothers. Glycosylated hemoglobin A1 values were used as a measure of metabolic control. Results: More than half of the children with diabetes (58.2%) had mild to moderate symptoms of anxiety or depression as compared to 9.3% of the controls. High EE was exhibited by 70.9% of the index group mothers in contrast to only 29.6% of the control group mothers. High maternal EE was not related to the psychopathology of children with diabetes. High maternal EE and in particular its EOI component and excessive detail (a subcategory of EOI) were related to poor metabolic control of the index children. Conclusions: Maternal EE is related to metabolic control in childhood diabetes; maternal EOI in particular is related to poor metabolic control. Mental health professionals should work with mothers of children with diabetes in an effort to modify such attitudes and emotions.
Psychiatric Symptoms Associated with Scleroderma
Authors: Angelopoulos N.V. , Drosos A.A. , Moutsopoulos H.M.
Published: April 2003

Background: The prevalence of psychiatric symptoms and hostility factors in patients with scleroderma, although a matter of clinical interest, it is rather poorly studied. Methods: Thirty female patients with scleroderma were investigated. Thirty-three healthy women were used as a comparison group. The applied psychometric instruments were the Hostility and Direction of Hostility Questionnaire (HDHQ), the Delusions Symptoms States Inventory/states of Anxiety and Depression (DSSI/sAD) and the Symptom Check List-90R (SCL-90R). Results: The scleroderma patients reported significantly increased depression and anxiety, somatization, interpersonal sensitivity and obsessive-compulsiveness. Paranoid ideation and psychotic symptoms scores were also increased. On hostility, they presented significantly higher scores predominantly on guilt. Conclusions: Psychiatric symptomatology in the form of anxiety, depression, obsessive-compulsiveness, somatization and feelings of guilt were reported by the majority of the patients with scleroderma.
Efficacy of ‘Functional Relaxation’ in Comparison to Terbutaline and a ‘Placebo Relaxation’ Method in Patients with Acute Asthma
Authors: Loew T.H. , Tritt K. , Siegfried W. , Bohmann H. , Martus P. , Hahn E.G.
Published: April 2003

Background: ‘Functional relaxation’ (FR) according to Marianne Fuchs is a body-oriented psychotherapy that involves teaching the patient a type of relaxation techniques aimed at maintaining equilibrium of the nervous system. Methods: In order to determine whether the practice of elementary parts of this therapy has an immediate beneficial effect on pulmonary function, a randomized, single-blind, prospective crossover study was done with 21 asthmatics with acute bronchoconstriction. On 3 consecutive days they were given either (1) a 5-min verbal standard instruction in elementary exercises of FR (eFR), which they were to practice during subsequent bodyplethysmographic measurement or (2) inhalative terbutaline (IT), a β2-sympathomimetic drug, or (3) an unspecific ‘placebo relaxation’ technique (PRT), so that all subjects tried all 3 treatments in random order. Spirometric variables were assessed. Results: There was a significant decrease in specific airway resistance with eFR, which, though not as pronounced as with IT, was significantly greater than with PRT. This study shows that clinically relevant effects can be achieved for patients with asthma through mind-body interaction, which can be triggered by reproducible procedures. Conclusion: Further development of the FR approach could lead to a nonpharmacological and effective supplementary treatment for asthma, which is in high demand by many patients.
Family and Past History of Mental Illness as Predisposing Factors in Post-Traumatic Stress Disorder
Authors: McKenzie Nigel , Marks Isaac , Liness Sheena
Published: April 2003

Background: Family studies of post-traumatic stress disorder (PTSD) have given inconsistent results to date. Identifying predisposing factors in PTSD compared to anxiety disorders may help to clarify the classification of PTSD as a diagnostic entity. Method: Retrospective case note study of 87 PTSD patients who participated in an RCT, and 51 PTSD patients and 87 agoraphobics treated routinely in outpatients. Results: Compared to agoraphobics, PTSD patients had significantly less family history of anxiety disorder but not mental illness in general. They also had significantly less personal history of mental illness prior to the index episode. Conclusions: Trauma precipitated PTSD in subjects who had significantly fewer premorbid predisposing factors than did agoraphobics. Such factors may predispose agoraphobics to become psychiatrically ill after more minor trauma. Research is needed to systematically compare the events which precipitate PTSD as opposed to agoraphobia and other anxiety disorders.
Psychological Evaluation after Cardiac Transplantation: The Integration of Different Criteria
Authors: Grandi Silvana , Fabbri Stefania , Tossani Eliana , Mangelli Lara , Branzi Angelo , Magelli Carlo
Published: April 2003

Background: The psychological evaluation of patients undergoing cardiac transplantation is currently based on DSM-IV criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. The aim of this study was to compare these new criteria (Diagnostic Criteria for Psychosomatic Research, DCPR) with DSM-IV in a population where a high prevalence of psychological problems is expected (heart-transplanted patients). Method: 129 consecutive patients who underwent heart transplant surgery were assessed according to DSM-IV and DCPR criteria. Results: The results showed a higher number of diagnoses made using the DCPR than with the use of the DSM-IV. At least one DCPR diagnosis was found in 85 (66%) patients, whereas at least one DSM diagnosis was present in 23 (18%) patients. The number of DCPR diagnoses was almost the triple of DSM criteria. While patients who were given a DSM diagnosis frequently had additional DCPR diagnoses, many patients with DCPR criteria did not fulfill any DSM criteria. Four DCPR syndromes appeared to be particularly frequent: demoralization, type A behavior, irritable mood and alexithymia. Conclusions: The joint use of DSM and DCPR criteria was found to improve the identification of psychological factors which could result in a worsening of quality of life in heart-transplanted patients.
Food Exposure in Patients with Bulimia nervosa
Authors: Neudeck Peter , Florin Irmela , Tuschen-Caffier Brunna
Published: April 2003

Background: The aim of the study was to investigate psychological and physiological responses of bulimic patients to the repeated presentation of food cues. Method: On 2 subsequent days, 48 bulimic women (DSM-IV) were confronted with high- or low-caloric food for 20 min. A control group (n = 24) was exposed to high-caloric food once. Blood sugar levels were manipulated with a glucose load. Results: High-caloric food only elicited increases in urge to binge, subjective and physiological stress in the first session. During the second session, reported urge to binge and subjective stress was significantly lower. Bulimic patients confronted with high-caloric food showed higher subjective and physiological stress in the first session compared to bulimic patients confronted with low-caloric food. In the second session, they reported more subjective stress and urge to binge, compared to the low-caloric group. Blood sugar levels did not affect psychological and physiological responses. Discussion: The results are discussed in terms of the conditioning model of binge eating model, habituation models and implications for exposure therapy.
Changes in Conflict, Symptoms, and Well-Being during Psychodynamic and Cognitive-Behavioral Alcohol Inpatient Treatment
Authors: Hoyer Jürgen , Fecht Jens , Lauterbach Wolf , Schneider Ralf
Published: April 2003

Background: According to Grawe’s psychological therapy approach, conflict reduction can be expected not only in psychodynamic, but also in cognitive-behavioral therapy (CBT). This was tested in an effectiveness study. Changes in cognitive conflicts, along with those of symptom severity and well-being were analyzed during alcohol inpatient treatment. Methods: Four times during treatment, groups of patients receiving psychodynamic therapy (n = 45 patients) or CBT (n = 49 patients) were measured and compared. Lauterbach’s Online Conflict Test was used to measure conflict. Symptom severity and well-being were measured using questionnaires. Results: Results showed significant conflict decrease in both groups with a tendency towards faster reduction under CBT. There was also significant change in symptom severity and well-being in both groups with no difference regarding reduction gradient. Moreover, patients in the psychodynamic treatment group exhibited lower symptom scores at treatment begin which may be a consequence of clinical group assignment. Conclusions: In general, the findings confirmed Grawe’s theoretical assumptions. Generalizability to other diagnostic groups and other clinical settings remains to be tested.
Why Do Alexithymic Features Appear to Be Stable?
Authors: Honkalampi Kirsi , Koivumaa-Honkanen Heli , Tanskanen Antti , Hintikka Jukka , Lehtonen Johannes , Viinamäki Heimo
Published: April 2003

Background: This 12-month follow-up study investigated the prevalence of alexithymia and its relationship with depression in a sample of the general population from Eastern Finland (n = 1,584). Methods: Alexithymia was assessed using the 20-item version of the Toronto Alexithymia Scale (TAS) and depression using the 21-item Beck Depression Inventory (BDI). Results: The prevalence of alexithymia in each study phase was similar (baseline: 9.7%; follow-up: 10.1%). Mean values of BDI, TAS-20 and subfactors of the TAS-20 also remained unchanged between the study phases. However, by using the original cutoff points, we found that a proportion of the subjects were in a different TAS-20 category on follow-up than at baseline. The mean values of BDI had not changed in those subjects who had similar alexithymia status in both phases, but increased or decreased in parallel with the change in TAS-20 score among all other subjects. Conclusions: Our findings indicate that it is important to use a variety of viewpoints when studying changes in alexithymia status. Alexithymia appears to be a stable trait based on the similarity of the mean TAS-20 scores in separate study phases. However, when focusing on the changes in alexithymia status at the individual level, alexithymic features also appear to be state dependent and strongly related to depressive symptoms.
A Follow-Up Study of Psychiatric Consultations in the General Hospital: What Happens to Patients after Discharge?
Authors: Rigatelli M. , Casolari L. , Massari I. , Ferrari S.
Published: April 2003

Background: An appropriate follow-up is considered essential in the consultation-liaison psychiatry setting, but it is often neglected. This study evaluated the effectiveness of the psychiatric consultation process in the general hospital, by investigating what occurred to patients 3–5 months after discharge. Methods: We used a three-part questionnaire: (1) the results of the consultation process; (2) a telephone interview with patients, and (3) a telephone interview with the patients’ primary care physician, to whom the patients were referred after discharge from hospital. We contacted all consecutive, unselected patients referred to psychiatric consultation from January to July 1999. Complete data were available for 119 patients from an initial group of 318. Results: The consultation process was well accepted by patients and useful to general hospital physicians to complete the final diagnosis of the patient when discharged from hospital. In most cases (78.9%), the psychiatric letter was attached to the discharge letter. The second part of the questionnaire indicated that most patients were satisfied with the consultation process. They thought it helped focus their problems and 60% asserted that they felt better after following their psychiatrists’ instructions or therapy. The primary care physicians agreed with the diagnostic results of the psychiatric consultation, mainly followed the psychiatrists’ advice, and generally expressed positive comments about the consultation-liaison service. Conclusions: Compliance of hospital physicians, patients, and primary care physicians was good. Follow-up studies on outcome of psychiatric consultations are few and further analysis is strongly recommended.
Intellect and Somatic Health: Associations with Hypochondriacal Concerns, Perceived Threat and Fainting
Authors: Ferguson Eamonn
Published: April 2003

Background: Compared to the other domains of the Big 5, intellect has been relatively underresearched with regard to somatic health outcomes. It is argued that this, in part, is because specific hypotheses concerning intellect and somatic health have not been formulated. It is argued that intellect is related to both alexithymia and hypnotic ability. As such the High Risk Model of Threat Perception forms one useful theoretical framework for generating hypotheses about intellect and somatic health. On this basis it is hypothesised that intellect should show a U-shaped relationship to hypochondriacal concerns, a positive association with appraisals of threat and loss, and a negative association with levels of self-reported vasovagal syncope (feelings of faintness). Methods: Two cross-sectional studies, using student samples (n = 205, 179), examined the relationships between intellect and hypochondriacal concerns as well as intellect and appraisals of threat and loss. A third prospective study, using a sample of blood donors (n = 373), examined the relationship between levels of self-reported vasovagal syncope and intellect. Results: Compared to the other domains of the Big 5, intellect demonstrated a U-shaped association with hypochondriacal concerns, a positive association with perceived threat and loss and a negative association with fainting. The negative association with fainting remained once incidence of previous fainting, the number of previous blood donations and emotional stability were held as covariates. Conclusions: Intellect is associated in a number of important ways with a variety of psychosomatic variables.
Structured Writing and Processing Major Stressful Events: A Controlled Trial
Authors: Schoutrop Mirjam J.A. , Lange Alfred , Hanewald Gerrit , Davidovich Udi , Salomon Henriëtte
Published: April 2003

Background: Traumatic events may result in a variety of physical and psychological health problems. Self-confrontation with traumatic memories, by putting painful emotions and thoughts into (verbal) words, is associated with psychophysiological benefits. Self-confrontation may be invoked during sessions and enhanced by structural assignments, which the client carries out between the sessions. In this context, writing assignments could be a useful tool in reprocessing traumatic events. The effects of writing assignments have been demonstrated in several case studies and in a number of experimental studies. However, the experimental studies have several limitations, for example the effects of writing on the impact of trauma are not examined. Furthermore, the psychological mechanisms that mediate the effects of trauma on health are less clear. These two issues are the main issues of the current study. Methods: A group of 26 participants were instructed to write about their negative events during five 45-min sessions over a period of 2 weeks. They were compared at pre-treatment, post-treatment and at 6-week follow-up to a waiting-list control group (n = 22). Results: The trauma-writing groups experienced fewer intrusions and showed less avoidance behavior from pre-treatment to follow-up, whereas the waiting-list control group did not change significantly. Similar results were found on depressive symptoms. No effects on mood measures were found. Conclusions: Implications for future research and clinical practice are discussed.
Treatment of Cystic Fibrosis in the Adult
Authors: Hodson Margaret E.
Published: April 2003

There has been a dramatic increase in the life expectancy of patients with cystic fibrosis (CF) over the last 20 years. CF used to be fatal in childhood but now, over a third of the patients are adults. The reasons for improved survival are multi-factorial. The disease affects most systems of the body although the majority of morbidity and mortality is due to lung disease. As in any life-threatening disease, in addition to medical issues, there are many psychosocial and spiritual issues, which need attention. Transition from paediatric to adult care needs to be handled very sensitively. Arranging a balanced and reliable system of care – out-patient, in-patient and home care – is essential to ensure the patient’s survival and quality of life is as good as possible.