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PubMed1985

Abdominal pathology in spinal cord injured persons.

The assessment and management of abdominal disease in persons with spinal cord injuries is extremely complex. Alterations in the normal conduction of impulses to the brain can result in symptoms that may be quite unlike those which are commonly associated with abdominal pathology. A number of features, however, have been identified which can assist the practitioner in the interpretation of the clinical evaluation. This article discusses those findings and the most commonly occurring abdominal disorders in which they are seen. Two case studies are presented which exemplify the symptomatology described and which reinforce the need for early accurate diagnosis and management of abdominal disease in spinal cord injured persons.

Adolescent↗

PubMed1993

[Clinical aspects and pathology of intracranial subependymoma--18 personal cases and review of the literature].

Intracranial subependymomas are rare, benign tumours (WHO grade I) occupying a special position compared to the other ependymal neoplasms. They often remain asymptomatic and, in consequence, are found incidentally at autopsy. In the present study clinico-pathological data of 84 symptomatic (8 own cases) and 58 asymptomatic tumours (10 own cases) are summarised. Subependymomas are more frequently situated in the fourth (58.4%) than in the lateral ventricle (38.0%). They occur predominantly in middle-aged and elderly males. Tumours in the lateral ventricles manifest themselves more often than those in the fourth ventricle. In general, asymptomatic subependymomas do not exceed a diameter of 1.2 cm. The nature of symptoms, with a median symptomatic period of 12 months, is usually associated with hydrocephalus, which is present in more than 80% of the symptom-producing subependymomas. Growth within the ventricular lumen and sharp demarcation from the surrounding brain tissue allow a complete removal in half of the cases. Radical extirpation can be achieved more often in patients with subependymomas located in the lateral ventricles than in those with tumours arising from the floor of the fourth ventricle. The high operative mortality, at a rate of 28.8% so far, mainly refers to the period before microsurgical technique was established. Recurrences are very rare, spinal seeding has not been found to date. For the assessment of long-term results further detailed compilation and documentation of individual follow-ups is necessary.

Adolescent↗

PubMedDate not supplied

[Personality picture of gout patients].

41 male patients (from the Medical Polyclinic of the University of Munich) suffering from gout have been studied with the semi-standardized psychoanalytic interview and psychological test methods. The result was that all of the patients had a pathologic narcissistic personality. They could be divided up into two groups: two thirds of the patients corresponded with the "philobats" and one third with the "oknophiles" of Balint's concept. Some aspects of the interview data could be verified by the standardized psychological tests. Beyond the metaphoric classification with Balint's concept it was interesting to find parallels to M. Mahler's observations on the mother-child-relation. Corresponding interpretations were possible. Questions concerning the illness behavior, the first attack of the gout together with the psychological conflict were discussed. Further research programs are considered necessary. Nevertheless there are reasons to presume that gout is a multifactorial disease with alimentary, genetic and psychological aetiopathogenetic conditions.

Drinking↗

PubMedDate not supplied

[Chronic pathologies and pharmaceutical expenditure in persons over the age of 65].

OBJECTIVE: For purposes of the present study of people over 65 attending a particular Health Centre, we aimed to discover and inter-relate their morbidity due to chronic illnesses, their frequency of attendance, and the total average outlay of drugs on them. DESIGN: Descriptive crossover study. Information on the clinical histories was gathered over a one-year period (July 1990 to June '91). SITE. Within the Primary Care framework: at the Vite Health Centre in Santiago de Compostela. PATIENTS OR OTHERS PARTICIPANTS: The population aged 65 or over and with medical records in the said centre. A representative sample of this population (n = 240), obtained by systematic sampling, was worked with. MAIN RESULTS: The sample's average age was 73.6 +/- 6.7 years. Arterial Hypertension (AHT) was the most common chronic illness. AHT, LCFA/Asthma, Hyperlipemia and digestive pathology showed significant differences between men and women. The average number of medical consultations per person per year was 11.5 +/- 0.82, with no significant differences as to sex and age. The average outlay per person per year was 27,610 pesetas +/- 38,688, with an average cost per consultation of 2,750 pesetas +/- 5,158.7. The chronic illnesses that produced a higher average total cost were heart diseases. Significant differences were shown between the number of chronic illnesses and the average total cost. CONCLUSIONS: The presence, number and nature of chronic illnesses are the factors affecting higher outlay in medication.

Aged↗

PubMedDate not supplied

Personality factors and weight preoccupation: a continuum approach to the association between eating disorders and personality disorders.

OBJECTIVE: Evidence shows a high comorbidity of eating disorders and some forms of personality disorder. Adopting a dimensional approach to both, our study explored their connection among a non-clinical sample. METHOD: 191 young women completed personality scales of general neuroticism, and of borderline, schizotypal, obsessive-compulsive, and narcissistic (both adjustive and maladaptive) traits. Weight preoccupation (WP), as a normal analogue of eating disorders, was assessed with scales from the Eating Disorder Inventory, and height and weight measured. The data were analysed with multiple regression techniques, with WP as the dependent variable. RESULTS: In low to normal weight subjects, after controlling for the significant influence of body mass, the specific predictors of WP in the regression model were borderline personality and maladaptive narcissism, in the positive direction, and adjustive narcissism and obsessive-compulsiveness in the negative direction. In heavier women, narcissism made no contribution--nor, more significantly, did body mass. CONCLUSIONS: Patterns of association between eating pathology and personality disorder, especially borderline and narcissism, can be clearly mapped across to personality traits in the currently non-clinical population. This finding has important implications for understanding dynamics of, and identifying individuals at risk for, eating disorders.

Adolescent↗

PubMed2005

The role of psychopathy and sexuality in a female serial killer.

The case of Aileen Wuornos, executed in Florida for the serial killing of seven men, is studied to determine her degree of psychopathy and the presence or absence of sexuality or sexual sadism as a motivation or gratification for her crimes. The authors, one of whom evaluated the subject shortly before her death, determined that she evidenced a psychopathic personality (PCL-R score 32). She also met DSM-IV-TR criteria for Antisocial Personality Disorder and Borderline Personality Disorder. While her killings ostensibly were carried out during routine acts of prostitution, there was ambiguous evidence that her crimes were sexually motivated or gratifying. Her articulated motivation was robbery and elimination of the witness/victim. After carefully considering all available data, the authors concluded there was no convincing evidence of sexual sadism in either her personal history or her method of committing serial murder, and it remains unclear whether sexual gratification was to some degree a motivating factor in her commission of these offenses. The confluence of early childhood attachment disruptions, severe psychopathy, other personality disorder pathology, and a traumagenic abuse history likely contributed to her having serially murdered seven victims.

Adult↗

PubMed1993

Sexual abuse and eating disorders: a review.

Studies investigating a possible relationship between sexual abuse and eating disorders have reported highly discrepant results. Some variability can be accounted for by methodological issues including diagnostic criteria, study design, and assessment techniques. The heterogeneity of an eating disordered population, especially regarding the comorbidity of eating pathology and personality disorder, is also a factor. Overall results suggest that around 30% of eating disordered patients have been sexually abused in childhood, a figure that is relatively comparable to rates found in normal populations. For some patients there may be a direct link between sexual trauma and eating pathology, but in general sexual abuse is best considered a risk factor in a biopsychosocial etiological model of eating disorders. Complex associations between trauma, self-regulatory deficits, and psychopathology require further research.

Adolescent↗

PubMed1993

[Forensic psychiatric diagnoses and assessment of abnormal psychosocial development].

Introduction of the concept of severely abnormal personality development in the legal code in the former GDR in 1968 (section 16, para 1) made acquittal of criminals possible where abnormal psychosocial development was proved. So far, however, statistically based criteria for the classification of this legal decision were lacking. The authors compared, using statistical methods, severely pathological abnormal personality development and a group of subject homogenized on the basis of substantial parameters. Mainly due to multivariance methods they were able to visualize different syndromes which are characterized by the given criteria of severely abnormal personality development.

Forensic Psychiatry↗

PubMedDate not supplied

Personality disorders in students with depressive pathology.

In a group of 111 students with depressive disorders, 70% presented a concurrent personality disorder and nearly 15% had prominent personality traits. The unstable, obsessive, hysteric and dysthymic types of personality disorders were relatively more frequent, the higher percent of cases (27.3%) being included in the mixed subgroup of these disorders. The patients with personality disorders had: an earlier age of affective illness onset, a more marked depression severity, a higher frequency of recurrent and nonreactive depression forms. Nonbipolar major depressive disorders were associated with the presence of unstable and dysthymic types of personality disorders, while minor depressive disorders were related with hysteric, asthenic and mixed ones.

Adolescent↗

PubMedDate not supplied

Personality disorders do not influence the results of cognitive and behavior therapy for obsessive compulsive disorder.

This study examined whether categorical or dimensional personality disorder variables affected treatment outcome in a sample of 52 patients with obsessive compulsive disorder who followed a standardized cognitive behavior therapy program. Treatment consisted of 12 weekly sessions and was completed by 43 patients. The Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) was taken before the start of treatment by an independent rater. The treatment outcome measures included questionnaires and a Behavioral Assessment Test. Measurements were taken before and after treatment, and at 1 and 6 month follow-up tests. After the first follow-up test, further treatment was provided if clinically indicated. Neither categorical, nor dimensional personality disorder variables affected treatment outcome significantly. The inclusion of drop-outs in the analyses, did not change these results. Therefore, patients with obsessive compulsive disorder and concomitant personality disorder pathology should not be excluded from cognitive or behavior therapy for their obsessive compulsive complaints. Attributing therapy failure to concomitant Axis II pathology should be approached with caution.

Adolescent↗

PubMed2002

Comparison of the effects of fluoxetine, imipramine and placebo on personality in atypical depression.

BACKGROUND: Atypical depression is associated with elevated rates of personality disorders. Studies have confirmed the efficacy of a several antidepressants in the treatment of atypical depression. Whether their pathological dimensions of personality diminish after benefitting from effective medication treatment is unclear. AIMS: To determine the extent that pathological dimensions of character improved among patients who benefitted from treatment. METHOD: One-hundred and fifty-four outpatients with DSM-IV Major Depression who met Columbia criteria for atypical depression were randomized to receive fluoxetine, imipramine or placebo for a 10-week double-blind clinical trial. The Temperament and Character Inventory (TCI) was administered at the initiation of treatment and 8 weeks later. Low scores on either of two Character dimensions (Self-Directiveness or Cooperativeness) indicate psychopathology. RESULTS: Responders had a substantial reduction in Harm Avoidance, but post-treatment scores remained significantly higher than the normal control group (NCG). Fluoxetine and Imipramine did not produce different changes on personality, except for Self-Transcendence. LIMITATIONS: High proportion of missing data, inadequate sample size, post-hoc analysis. CONCLUSIONS: Among responders, Self-Directiveness improved and normalized; Harm Avoidance also improved but did not normalize. These data suggests that effective treatments reduce some pathological personality traits as well as improving mood.

Adolescent↗

PubMed1984

[Prevalence, risk factors and complications of peripheral venous diseases in the Munich population].

Prevalence, risk factors, and complications of peripheral venous disease of the lower limb were examined in a prospective study on 1,000 unselected outpatients of a polyclinic. The investigation was planned as a representative epidemiologic study in the Munich area, with the intention of getting information on the sociomedical importance, therapy, and possibilities of prevention of peripheral venous disease. Prevalence. Of the patients examined 50% showed peripheral venous abnormalities, which were unimportant in 25%, relevant in 10%, and pathologic in 15%, i.e., one of seven patients had significant venous problems. No significant differences dependent on sex were found. The prevalence of peripheral venous disease grew with increasing age. Medical reliability. The striking sociomedical importance of peripheral venous disease was demonstrated by the high rate of complications, such as thrombophlebitis, chronic venous stasis, and embolism. Nearly every other person with pathologic venous changes suffered from thrombophlebitis, every 3rd from a chronic venous stasis, every 4th from ulcera of the legs and every 10th from embolism. Risk factors. Especially the varicose saphenous veins seemed to depend on risk factors such as overweight, standing position at work, herniae, flat and/or spread feet, familial disposition, age and pregnancy. In women and men peripheral venous disease proved to be very closely correlated with a positive familial disposition. In male patients there were further correlations with hernias and a standing position at work, and in women with flat or spread feet. Overweight, pregnancy or multiple pregnancies are recognized as aggravating factors with only tendentious correlations. The most important recommendation to people with peripheral venous disease is early medical treatment to prevent progressive disease. Complications can probably be markedly reduced by early treatment.

Adult↗

PubMed1992

Revisiting the Rorschach of Sirhan Sirhan.

The published Rorschach (Kaiser, 1970) of Sirhan Sirhan, the man who assassinated presidential aspirant Robert F. Kennedy in 1968, was studied. Psychostructural and psychodynamic analyses were conducted using reliable and valid methodology that was unavailable at the time of examination. In contrast to the defense experts at trial who diagnosed paranoid schizophrenia, the data suggest a depressed and suicidal individual organized at a borderline level of personality. Character pathology is hysterical, paranoid, and dependent. When the Rorschach findings are compared to the development history of Sirhan and the behavior around the time of the assassination, the data are somewhat consistent with the theme of psychic trauma, are very consistent with the theme of recurrent loss and pathological mourning, and validate a characterological distrust and hatred of, yet hysterical dependence on, the object world. Rorschach indices of predatory violence (Meloy, 1988a) in relation to the planned and purposeful assassination are also discussed.

Adult↗

PubMed1990

[The status and outlook of the training of pathologists in the RSFSR].

Pathology service in the RSFSR suffers, at present, from the lack of pathologists: only 2393 (57.3%) of 4174 positions are occupied. Particularly difficult is the situation in Eastern Siberia and Moscow where only 47.7 and 48.6% positions, respectively, are covered. Lack of professional pathologists is aggravated by an artificial decrease of positions number as compared to real need, by the increase of proportion of persons retired or those having a preretirement age (30%), by a high percentage (over 30% of positions) of persons experiencing pathology as a second profession (65% of them do not have a sufficient knowledge and practice in pathology), by a low level of medical education in general and nonsufficient promotion of pathologists (only 39.3% pathologists have attestation categories). To solve the crisis the RSFSR Ministry of Health started in 1988/89 4-year training of pathologists at the pathology chairs of the RSFSR Medical Institutes: subinternship (1 year), internship (1 year), clinical internship (2 years). The realization of this program will result in turning out of 724 pathologists by 1994. The progress in pathologists training will require the improvement of technical basis of pathology chairs and departments and solution of certain organizational problems.

Certification↗

PubMed1978

[Clinical and cytological examinations on industrial workers exposed to mineraloilaerosols (author's transl)].

Clinical, roentgenological and spirometric examinations were performed on 217 industrial workers exposed to mineraloilaerosols and 197 control persons. No pathological results were to be found which could be connected with the professional employment. In both groups only in a few sputa lipid in respiratory epithelium cells was seen. We also did not find any evidence according to connection with the employment. The oilaerosolconcentrations were normaly, but during the unloading soot for a short time concentrations of anthrazeneoilaerosols up to 30 milligram per cubic meter were measured. Sputa provoced on persons with an empty stomach using aerosols of hypertonic salt solution were more effective than unprovoced sputa and sputa after meal.

Air Pollutants, Occupational↗

PubMed1975

[Significance of the PV 1 index in the ECG of diabetes mellitus and in the early forms of chronic ischemic heart disease].

In 152 patients with diabetes mellitus, chronic ischaemic heart diseases and hypertension the so-called ptf-product resulting from the height of the amplitude of P and its time of spreading) measured in the lead V1 (PV1-index), was determined and compared with the values of 93 persons with healthy heart. Patients of the groups of diseases mentioned showed significantly higher pathological values than persons with healthy heart (limiting value -0.02 mms). A comparison between patients with chromic ischaemic heart disease at the age of 36-55 years and a group of diabetics of the same age without the clinical signs of an ischaemic heart disease resulted in no statistically ascertained differences. But compared with a group of persons with healthy heart of the same age the groups clearly differed: 63.9% of pathological values in the total group of disease compared with 18.5% of pathological values in persons with healthy heart. In 137 patients with latent diabetes (protodiabetes) in 54.7% also pathological ptf-values were found. It is possible that the determination of the ptf-product is able to ascertain already early forms of a chronic ischaemic heart disease still before its clinical manifestation. The large number of pathological values in patients with protodiabetes could be a first reference to early beginning disturbances of the left-sided atrial activity in the sense of a microangiopathy.

Adult↗

PubMed2001

Eating disorders and sexual abuse.

This review examines the current debate on the role that sexual and physical abuse may play in predisposing to eating disorders in women. Despite some discordant opinions, clinicians agree that the experience of abuse in early childhood may be important for understanding the complex genesis of the eating disorders of some women. Three groups of studies are presented: those in which no connections emerge between sexual abuse and eating disorders, those in which a strong link is present and those in which the results refer to a multifactorial interpretative model. Some of the main symptoms, such as reactualization of the trauma, dissociation, personality disorders, pathological relationship with food, distortion of body image, suicide attempts and self-inflicted punishment that victims of abuse and eating disordered subjects share are examined.

Adolescent↗

PubMed1998

[Eosinophils: protection or pathology: a cell with two personalities].

Expression of various membrane receptors on human eosinophils for immunoglobulin, complement, certain cytokines and chemotaxis factors, and adherence molecules as well as CD4 and class II major histocompatibility complex antigens has led to a reconsideration of the role of the eosinophil in the immune response. Eosinophils are able to present antigen and become infected by HIV. Eosinophils are not to only source of cytotoxic and proinflammatory mediators but can also release different cytokines and growth factors including their own differentiation factors. The recent demonstration that eosinophils can express IgE-binding molecules belonging to different multigenic families as well as two different IgA receptors which participate equally to the protective and to the pathological inflammatory responses reinforces the concept of a dual functionality for the eosinophil.

Eosinophils↗