[Proceedings: Reactive thyrotropic adenomes. 2 surgically confirmed cases].
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Adenoma↗
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Developmental themes in women's emotional experiences of motherhood.
In this study, women's levels of ego development and their psychological difficulties were examined in relation to feelings in the maternal role. The sample consisted of 91 mothers from diverse socioeconomic backgrounds. Ego development was assessed by the Washington University Sentence Completion Test, and psychological difficulties were operationalized by self-reported global symptomatology, maternal substance abuse, and expressed anger. Outcome variables included feelings of satisfaction, distress, and support in the maternal role, as well as the degree to which negative and positive emotions were integrated in response to hypothetical vignettes of challenging everyday child-rearing experiences. Hypotheses were that women at high levels of ego development would show greater deterioration in the presence versus absence of self-reported adjustment problems than would those at lower levels. A series of interaction effects each indicated trends consistent with the hypotheses. These results add to accumulating evidence that tendencies toward self-examination, characteristic of high developmental levels, do not inevitably serve protective functions but may be linked with heightened reactivity to negative intrapsychic forces.
Adolescent↗
Effect of pregnancy on psychosis: life circumstances and psychiatric symptoms.
As part of an ongoing prospective study to correlate mother and infant outcome with social isolation during pregnancy, the Schedule for Affective Disorders, SADS-C, was administered to twenty-seven psychotic patients late in pregnancy. Extensive standardized evaluation of life stresses and social supports included a Prenatal Interview with sixty items relating to demographics, drug use, health and obstetrical history, family involvement and development expectations of the infant, and a thirty-item Difficult Life Circumstances questionnaire. In this sample the patients' previous life adjustments were stabilized by their pregnancy unless the pregnancy itself created personal stress for the patient. Higher scores on Difficult Life Circumstances were found to be associated with more psychiatric symptomatology. Symptoms of pregnancy confounded SADS-C items measuring vegetative signs of depression. One group of items on the SADS-C appeared to selectively identify a subset of women whose underlying affective symptomatology was potentiated by pregnancy. A second group of items identified women whose symptoms appeared to be reactive to current situational strains.
Adaptation, Psychological↗
[Round Table: Urticaria caused by arthropod bites and stings (excluding Hymenoptera)].
Adverse reactions to arthropod bites (hymenoptera excluded) can be faced with systemic reactions and local reaction. Among the numerous families of arthropods the species most commonly responsible are mosquitoes,. flea, horsefly and tick. In this article we explain the characteristics of reaction caused by arthropods and the mechanisms proposed. An IgE mechanism is incriminated in severe anaphylactic reactions. Various mechanisms have been proposed for local reactions. In order to know the incidence of sensitization and cross-reactivity with other arthropods, we have done a study where we have found that 31% of patients with reaction to mosquito bite had sensitization to Aedes communis and 53% of this group also had sensitization to other arthropods, probably due to a cross-reactivity.
Adult↗
Reactivation of Hand-Schüller-Christian disease six and thirteen years after discontinuation of systemic therapy.
We present two cases of reactivation of Hand-Schüller-Christian disease or multifocal eosinophilic granuloma 6 and 13 years after discontinuation of systemic therapy. Both patients received oral therapy with methotrexate and prednisone continuing for 2--3 years after the disease was thought to be in remission. Relapses were detected because of disease symptoms and treated with surgery with or without radiation. Neither patient has required reinstitution of systemic therapy. These cases are cited as evidence of the chronicity of the disorder and as a reminder that reactivation is possible after years of disease inactivity. Therefore, long-term clinical follow-up of patients in remission is indicated.
Child, Preschool↗
"I'm sorry I did it... but he started it": a comparison of the official and self-reported homicide descriptions of psychopaths and non-psychopaths.
This study concurrently examined the characteristics of violent actions (homicides) and the manner in which the violent acts are described by the perpetrators. N=50 offenders incarcerated for homicide were classified as psychopathic or non-psychopathic, according to the Psychopathy Checklist-Revised (Hare, 1991, 2003). The instrumentality/reactivity and major details of their violence were coded from the official files. Further, the offenders' own accounts were coded on the same variables by independent raters. Results indicated that whereas psychopaths were far more likely than their counterparts to have perpetrated primarily instrumental homicides, this difference disappeared when examining the self-report descriptions. Overall, although psychopaths and non-psychopaths both tended to exaggerate the reactivity of their homicides, psychopaths did so to a greater degree. Psychopaths also were more likely to omit major details of their offenses.
Adolescent↗
Postburn respiratory injuries in children.
Respiratory tract injury is a leading cause of mortality, morbidity, and prolonged hospitalization in fire casualties. Direct insults include inhalation of superheated gas, steam, smoke, or toxic fumes. Indirect injury may result from interference with the mechanics of respiration. Pulmonary injuries result from sepsis, fluid overload, endogenous reactive substances, and "shock lung," and also occur secondary to metabolic disturbances resulting from hypoxia.
Bronchodilator Agents↗
HIV infection-associated inflammatory musculoskeletal disorders.
Inflammatory musculoskeletal complaints are relatively common during the course of HIV infection, although they tend to be more frequent during late stages. The clinical spectrum is varied, ranging from arthralgias to distinct rheumatic disorders, such as Reiter's syndrome and psoriatic arthritis. The therapeutic management often poses a challenge, although most patients respond to conventional first- and second-line anti-inflammatory medications.
Adult↗
Hepatitis C viral clearance and antibody reactivity patterns in persons with haemophilia and other congenital bleeding disorders.
We studied hepatitis C virus (HCV) clearance and antibody reactivity patterns in a cohort of 100 haemophiliacs exposed to unsterilized blood products, of whom 25 were antiHCV negative and 75 were antiHCV positive [49 human immunodeficiency virus (HIV) negative and 26 HIV positive]. HCV RNA was measured by the 2.0 bDNA assay and an 'in-house' polymerase chain reaction assay. Antibody reactivity patterns were examined using a recombinant immunoblot assay (RIBA). Prior HCV infection was found in two (8%) of 25 antiHCV negative patients. HCV viraemia persisted in all 26 antiHCV+ patients who were coinfected with HIV. HCV RNA clearance was found in 12 (25%) of 49 antiHCV+, HIV- patients. Viral clearance was associated with younger current age (P < 0.01) and age at infection (P < 0.001), but not with duration of infection or with dose or frequency of clotting factor use. RIBA ratios reflecting an index of each patient's overall reactivity to four HCV epitopes were significantly lower in those with viral clearance (P < 0.0001). Over a period of 15 years, those with viral clearance demonstrated significant loss of reactivity to the NS3, NS4 and NS5 epitopes, while those with viral persistence demonstrated relatively stable reactivities to all epitopes. We conclude that spontaneous HCV RNA clearance in haemophiliacs is age-related and is unlikely to occur in those coinfected with HIV. The loss of antibody reactivity for some epitopes, especially c22 (core), may be a marker for the natural resolution of chronic HCV infection.
Adolescent↗
The neurobiology of stress: understanding regulation of affect during female biological transitions.
This article provides an overview of the neurobiology of stress and how dysfunction of the stress system may be related to psychological or behavioral processes that emerge during biological transitions across the life span of a female individual. These transitions involve distinct hormonal changes that may or may not be accompanied by external physical changes and concomitant psychosocial adaptations. The biological transition include the intrauterine and neonatal periods; puberty, including both adrenarche and gonadarche; pregnancy and the postpartum period; and the perimenopausal and menopausal periods. We propose that biological transitions are times of increased psychological and physical vulnerability for some individuals, and this vulnerability may be related to concurrent changes in the reactivity of the stress system. Models for examining hormone-behavior relations during biological transitions are discussed along with specific research and clinical examples of disorders of the stress system temporally associated with female biological transitions.
Adolescent↗
Serum concentrations of albumin, C-reactive protein, alpha 2-macroglobulin, prealbumin, fibronectin, fibrinogen, transferrin, and retinol binding protein in 55 patients with hepatic glycogen storage diseases.
Hepatic glycogen storage diseases are hereditary metabolic disorders involving the metabolism of glycogen. This study was designed to investigate the serum protein status in such diseases. Fifty-five patients with glycogen storage disease types I, III, VI, and IX, whose ages ranged from 1 month to 27 years, were included in this work. C-reactive protein, fibrinogen, alpha 2-macroglobulin, albumin, transferrin, fibronectin, retinol binding protein, and prealbumin serum concentrations were measured in each patient. In patients affected with type I glycogen storage disease, serum concentrations of alpha 2-macroglobulin, fibrinogen, C-reactive protein, and transferrin were significantly increased. In patients with types III, VI, and IX glycogen storage diseases, the concentration of alpha 2-macroglobulin was the only one that was significantly increased. Thus, even though this study raises more questions than it answers, it seems likely that the hepatic synthesis of some proteins may be increased in patients affected by hepatic glycogen storage diseases. This may indicate some degree of mild hepatic dysfunction in such metabolic disorders. However, further investigations are required to elucidate the discrepancies observed among the different types of diseases.
Adolescent↗
Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing.
Obstructive sleep-disordered breathing is associated with cardiovascular disease in adults, and elevated C-reactive protein (CRP) has been proposed as a link between the two disorders. We hypothesized that children with sleep-disordered breathing have higher CRP values than do control subjects. CRP was measured in 39 children (mean age +/- SD: 6.9 +/- 3.2 years) without snoring (controls) and in 102 children (6.2 +/- 2.2 years) with habitual snoring who underwent polysomnography. No significant differences were found in mean CRP values between control subjects (0.12 +/- 0.16 mg/dl; n = 39) and snorers with an apnea-hypopnea index of less than 1 episode/hour (0.15 +/- 0.26; n = 18), snorers with an index of 1 or more and less than 5 (0.15 +/- 0.26; n = 54), and snorers with an index of 5 or more (0.22 +/- 0.43; n = 30; p > 0.05). There was no correlation between CRP or log-transformed CRP values and apnea-hypopnea index, respiratory movement/arousal index, Sa(O(2)) nadir, oxygen desaturation (>/= 4%) of hemoglobin index, or percentage of sleep time with saturation less than 95% (p > 0.05). Thus, findings of higher CRP values in adults with sleep-disordered breathing and correlations of these values with polysomnography indices were not confirmed in children.
Adolescent↗
Reactive oxygen metabolites and prooxidant status in children with Down's syndrome.
Children with Down's syndrome suffer many diseases among which cardiovascular diseases, increased susceptibility to infections, leukemia, endocrine alterations, immune defects, nutritional disturbance and mental retardation have clinical relevance. It has been suggested that the pathogenesis of Down's syndrome involves reactive oxygen species arising from a mutation in gene encoding, which disproportionately elevates superoxide dismutase activity. Reactive oxygen species and total antioxidant capacity were evaluated using two new spectrophotometric methods in a selected group of 40 children with Down's syndrome and in 20 apparently healthy children used as controls. Reactive oxygen species were significantly higher (p <0.05) in children with Down's syndrome than in controls: 452 (+/- 72) U.Carr vs. 270 (+/- 66) U.Carr respectively. Total antioxidant capacity was significantly higher (p <0.05) in controls than in children with Down's syndrome: 380 (+/- 52) micromol hypochlorous acid (HCLO)/ml vs. 281 (+/- 33) micromol HCLO/ml, respectively. In fact, thiol groups (sulfhydryl) were significantly higher (p <0.05) in controls than in children with Down's syndrome: 644 (+/- 78) micromol/l vs. 462 (+/- 54) micromol/l, respectively Our data show how to simply measure chemical indices of oxidative status in serum samples from children with Down's syndrome. We determined the plasmatic activities of reactive oxygen metabolites and oxidative defense molecules. Accumulated macromolecular damage may be one of the causes of some of the abnormalities that are considered part of the syndrome. Therefore, children with Down's syndrome have to cope with a significant prooxidant environment. Oxidative stress causes alterations such as atherosclerosis, early aging, immunological default and neurologic disorders in Down's syndrome patients. The new test available for measuring reactive oxygen species in serum proved to be reliable and useful as an early marker of tissue damage.
Adolescent↗
Evidence to show MHC-linked factors other than HLA-B27 governing susceptibility to spondylo-arthropathies in Asian Indians.
The HLA antigen profile of 129 North Indian patients with ankylosing spondylitis, 66 patients with Reiter's syndrome and 57 patients with 'unclassifiable' arthritis was compared with 380 normal, healthy controls. Besides B27 which appeared with a significantly increased frequency in the three patient groups, other HLA antigens, viz. A2 and B35, showed deviated frequencies. The HLA supratype A2, B27 was found to be at an elevated frequency in patients with ankylosing spondylitis and unclassifiable arthritis whereas the B35, B27 combination showed a decreased frequency in our Reiter's syndrome sample. These data suggest that besides B27, other HLA-linked factors influence susceptibility to spondylitic disorders and might act as 'modifier' genes for the type and severity of spondylo-arthropathy in a B27-positive individual.
Adolescent↗
A developmental-psychodynamic model for diabetic control.
This paper elaborates a psychodynamic-developmental model as a framework for understanding the wide range of adaptive and maladaptive responses to the self-care requirements of diabetes. Early life experience participates with other factors in influencing the ease with which diabetics implement diabetic control. This model emphasizes the importance of the mother-child interaction during the second phase of development, the toddler phase, at which time the child begins to establish a sense of autonomy and control over his own body and its functions, with bowel training viewed as a paradigm for body control. It is postulated that certain types of mothers such as controlling-intrusive mothers, overprotective mothers, or guilty, indifferent, or rejecting mothers create problems for the child related to the development of autonomy and the sense of comfortable and pleasurable control over his bodily functions. Conflicts generated during this period are reactivated with the onset of diabetes and lead to difficulty in implementing control. In some situations where conflicts with the caretaker figure were predominantly limited to aspects of control, trusting relations acted as a substrate for change and improvement in control in a supportive medical environment. Specific management recommendations based upon this model are presented.
Adaptation, Psychological↗
Beyond abuse: the association among parenting style, abdominal pain, and somatization in IBS patients.
This study assessed the relative strength of the association between abuse, negative parenting style, and somatization in irritable bowel syndrome (IBS) patients. Drawing from preclinical stress physiology and abuse research identifying the family social climate as a frequently stronger and independent determinant of long-term health effects than abuse-specific variables, we predicted that negative parenting behaviors would more strongly correlate with somatization than abuse. Subjects were 81 consecutively evaluated patients, who at baseline underwent psychological testing, measuring perceived parental style, abuse history, somatization, and pain. Although abuse correlated with maternal and paternal rejection, abuse was not associated with somatization. Higher levels of rejection and/or hostility among fathers (not mothers) were more strongly correlated with somatization than was abuse. Further, paternal parenting behaviors were more predictive of somatization than abuse, age, and gender. The lack of an association between abuse and somatization is discussed in light of limitations of biopsychosocial IBS models, whose strong focus on "pathological stressors" (e.g., abuse, trauma) as risk factors may overlook the importance of "less extreme" parenting variables in influencing somatic complaints. The relationship between parenting and somatization is discussed in the context of broader behavioral science research linking disruptions in the quality of parenting to dramatic and long-term changes in patterns of stress reactivity and brain abnormalities seen in IBS patients.
Abdominal Pain↗
Executive cognitive functioning predicts reactive aggression in boys at high risk for substance abuse: a prospective study.
This study assessed the ability of executive cognitive functioning (ECF) to predict reactive aggression in boys at high and low risk for substance abuse using a 2-year prospective design. ECF is defined as the self-regulation of goal-directed behavior. Reactive aggression involves impulsive hostile reactions committed with little forethought. ECF was measured using five neuropsychological tests in 198 10- to 12-year-old boys with (SA+) and without (SA-) a paternal history of substance abuse/dependence. Reactive aggression was measured, 2 years later, using a composite index of items derived from two self-report measures. It was hypothesized that ECF would predict reactive aggression, and that this relation would be stronger for the SA+ compared with the SA- boys. SA+ subjects demonstrated lower ECF scores and higher reactive aggression scores, compared with SA- controls. ECF predicted reactive aggression in the SA+ group (beta = 0.37, p = 0.001), but not in the SA- group (beta = 0.09, p = NS). This suggests that compromised ECF may be a risk factor for reactive aggression in SA+ youth. The hypothesis that the relation between ECF and reactive aggression is a manifestation of a mild dysfunction of the prefrontal cortex is discussed.
Aggression↗
Dental management of children with asthma.
Asthma affects about 1 in 10 children. The condition is characterized by acute respiratory distress brought on by environmental factors. The condition is treated with medications aimed to reduce reaction to stimulants by the airway. Dental management involves attention to the status of the patient and awareness of stimulants of the reactive airway. Clinical recommendations are provided.
Acute Disease↗