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White-matter lesions (WML) detected on MRI may reflect different pathologies, but, in older persons, are thought to be mainly of ischemic origin. WML increase in prevalence with age. Several cardiovascular risk factors and cognitive, emotional, and physical function consequences of WML have been identified. These are reviewed briefly in this report.
INTRODUCTION: The measurement of quality of life is an increasingly important issue, particularly in regard to treatment of severe and chronic diseases. The aim of this pilot study was to assess potentially divergent profiles of quality of life in persons with two different pathologies: moderate dementia and cancer. METHOD: This pilot study was carried out in the neurology and cancer services of the medical school in Montpellier, France (Hôpital Gui de Chaulliac and CRLC Val d'Aurelle). The cumulative self-reporting test WHOQOL 100 (World Health Organization Quality of Life with 100 questions) was administered in 57 patients with either moderate senile dementia (27 cases with a Mini-Mental State Examination score >15; mean age of 73) or cancer (30 cases, mainly women with breast cancer; mean age of 53). The stability of responses was tested in a 2-week period. RESULTS: Results of the study showed clear and significant differences between the two groups in the domains of mobility and psychology. Further, eight questions and six facets with a significant difference in responses were found. Responses seemed more stable in the domains of autonomy, social relationship, and religion for the cancer group, and in autonomy and psychology for the dementia group. The age difference may be an important factor in the different quality of life measured but did not significantly influence responses to the test questions. CONCLUSION: The WHOQOL 100 seems a powerful instrument to assess quality of life in diseases such as cancer and moderate dementia. In this study, interesting differences in responses to the test questions between the two pathologic conditions were identified. Items that were unreliable on retesting are singled out. These results will be applied and reevaluated in the development of future, illness-specific and shorter versions of the WHOQOL 100.
Arguments for treating racism as an illness or an addiction are critiqued, and it is suggested that such efforts constitute a step backward in the battle against racism and discrimination. Medicalization, rather than being a catalyst for social change, is a mode of social control. The assumptions underlying the disease model are examined, and a strategy is outlined for dealing with racism as a structural phenomenon broader and more complex than personal prejudice and individual pathology.
The bone-anchored hearing aid (BAHA) is an effective means of intervention, its use being well documented in persons with chronic conductive pathology and congenital aural anomalies. This article describes the standard guidelines (both auditory and extraauditory aspects) for patient selection and expands the criteria to include bilateral BAHA implantation, unilateral conductive hearing loss, and unilateral profound sensorineural hearing loss. The BAHA's development, design features, and patient outcomes are also reviewed. Suggestions are presented for fitting, counseling, and following BAHA users.
Electromyographic (EMG) recordings taken from 13 orofacial and mandibular muscles during a sequence of nonspeech movements were compared in six normal and six cerebral-palsied adult subjects. Abnormalities in the amplitude of muscle activity and timing of muscle control in the cerebral-palsied subjects were borne out in statistically significant differences between the two subject groups on five measures of muscle activity. The findings do not support hypotheses that weakness affects individual upper airway muscles in cerebral-palsied persons or that a pathological imbalance between positive and negative oral reactions is present in these subjects. A possible mechanism for hypertonicity in facial muscles in cerebral palsy is suggested, based on inappropriate activation patterns across muscles. The results are consistent with a previous proposal that a defect in the specification of motor commands and/or their communication to muscles is a fundamental abnormality in cerebral-palsied individuals which affects both speech and nonspeech motor control.
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The data relating diet to coronary heart disease, when critically examined, clearly show that there is a normal spectrum of blood serum values, and that normal persons do not develop pathological levels upon the ingestion of eggs and other cholesterol-containing the ingestion of large amounts of cholesterol-containing foods. Average data obtained from mixed populations of normal and pathological blood lipid values should not be used to advise the normal majority of that population. The harmful effects of such policy are outlined. The data demonstrating the concept that the risk of coronary heart disease is a function of serum lipids at any level is no longer valid are reviewed. The data of the National Cooperative Pooling Project of the American Heart Association are used to show that up to 250 mg/dl there is no relationship between serum cholesterol concentration and risk.
Disease and illness are not synonymous. In most instances, disease is demonstrable by anatomic, physiologic, biochemical, microbiologic, or immunologic abnormalities. Disease is a pathologic process. Not all persons with a disease are sick or ill. Symptoms of illness associated with a disease may be manifest or persist after the disease has disappeared. The absence of demonstrable disease, however, does not necessarily mean that symptoms of illness are unreal. Recovery from disease and recovery from illness are not always equated. Many factors, including personal characteristics and social circumstances, can be responsible for recovery from disease and illness. Chronic fatigue syndrome or symptoms of illness can persist in some patients but not in others after many different diseases.
Since 1960, it has been demonstrated by various analytical procedures that high concentrations of arsenic were present in Napoleon's hair. Various authors, indicating that the detected arsenic levels are a consequence of external contamination, have challenged the results of these examinations. In order to shed more light on this historical controversy, we have tested two samples of Napoleon's hair by inductively coupled plasma-mass spectrometry (ICP-MS). The samples of hair were decontaminated with acetone and were cut into small segments. For multi-element screening, hair samples were mineralized in concentrated nitric acid for 1 h at 70 degrees C, diluted 1:40 in specific solution with rhodium as an internal standard, and finally analyzed by ICP-MS on a Thermo Electron ICP/MS X7. Multi-element analysis of Napoleon's hair samples revealed massive amounts of arsenic (42.1 and 37.4 ng/mg), antimony (2.1 and 1.8 ng/mg) and elevated levels of mercury (3.3 and 4.7 ng/mg) and lead (229 and 112 ng/mg). In the case of arsenic, these concentrations, 40 times higher than the normal values, confirm the hypothesis of a significant exposure to arsenic. The concentrations of the other elements, in particular antimony and mercury, are in agreement with the data already known about the therapeutic treatments given to Napoleon, which were based on calomel (salt of mercury) and tartar emetic (antimony).
A growing number of people are involved in recreational physical activity. It is therefore not uncommon for a medical examiner to encounter sports-related sudden deaths and to be faced with the legal implications. The authors examined the clinical and cardiac pathologic patterns in 31 persons who died suddenly during sports activities and underwent autopsy at the Institute of Forensic Medicine of Paris between 1991 and 2001. Twenty-nine male subjects, ranging in age from 7 to 57 years (mean 30 years) and two female subjects, 8 and 60 years old, died suddenly during sports activities. The sports involved were various, with running the most frequent: 13 cases. Cardiomyopathies (10 cases) and coronary artery disease (9 cases) were the most frequent causes of deaths. Despite the severity of lesions, only 4 subjects had a known cardiovascular disease. In conclusion, with regard to prevention, efforts should be continued to improve the sensitivity and specificity of diagnostic tools and screening strategies. In this regard, medicolegal autopsies should be systematically performed in cases of sudden death during sports activities, because they provide accurate and useful information for a better knowledge of sports-related mortality.
The purposes of the present investigation were to examine various ways of measuring cementum thickness, to study its relationship with age, and to consider what contribution this factor might offer in methods for age estimation. The amount of dental cementum apposition was studied in 1000 teeth, excluding molars, from a Caucasian population. Cementum thickness was estimated according to the scoring methods suggested by Gustafson and by Johanson. In addition, the width of the cementum was measured at the apex and also at approximately one third of the root length from the apex. Statistical analyses using the SPSS package in a Cyber computer indicated a symmetric left/right distribution of cementum thickness. The sum of the cementum thickness on vestibular and lingual surfaces, measured at one third of the root length from the apex, showed the strongest correlation with age (r = 0.40 to 0.65). A reduced rate of cementum apposition was observed in the elderly. Also, maxillary teeth had more cementum on the lingual than on the vestibular surfaces. A tendency was noted for less cementum to occur in women than in men and on teeth removed from deceased persons or extracted for pathologic reasons. Correlation coefficients indicated that, for at least some types of teeth, the cementum thickness might give a significant contribution to statistical methods of age assessment.
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Two patients are described in whom ordinary means of communication were disrupted by the deployment of primitive defensive mechanisms that prevented the author from integrating affect, context and counter transference to provide meaningful communication of a straight-forward kind. In the first, thinking was fragmented and projections into the analyst were difficult to tolerate; in the second, a dissociation appeared between affect and language. The author describes how with both patients he was led to behave as if he could put right the deficit he encountered in their means of communication and how at times he could recognise what was happening and interpret the state that the patient was evading, but at others was led into enactments that interfered with containment and understanding. Nevertheless, these allowed an examination of the type of object relations that the patients demanded and believed they needed. The author considers that the state of mind this produced in him was partly an evacuation of states that the patients could not cope with, but also represented a means of enlisting him to carry out functions that they could not or would not tolerate. Both patients used the sessions to create a manageable situation that functioned as a psychic retreat that he was instrumental in sustaining and that helped them avoid contact with reality, impeding their development. However, recognising the role he enacted also advanced the understanding of the nature of the retreat and of the underlying pathological organisation of the personality.
Patients with pathological organisations of the personality present the analyst with considerable technical difficulties. One of these problems arises from the fact that, in such patients, dreams frequently are not being used for communication of unconscious meaning, but instead for purposes of manipulation of the transference situation. They then represent attempts to identify the analyst with a part of the patient's self or with a particular internal object in order to draw him/her into collusive enactments. Following the work of Bion and Segal the paper presents a two-dimensional model in order to clarify the structure and use of dreams in this situation. The model may serve as a background orientation for the analyst in the clinical situation, as is subsequently illustrated in a detailed clinical sequence with a borderline patient. To conclude, the author suggests that whenever tendencies towards acting in are predominant, the interpretation of the enactment should generally be given preference over the interpretation of the dream content. The possible advantages and disadvantages of both strategies of interpretation are discussed. Finally, the author highlights consequences that arise when dealing with countertransference.
The authors describe the process of recovering from anorexia nervosa as it is revealed by 13 women who have recovered from the illness. Emphasizing the patient's perspective, the paper reviews the perceived causes of the disorder, helpful and harmful therapy-related and life experiences, features hardest to change, the defensive function of anorexia nervosa and residual traits. Generally, the movement toward health entails forming a therapeutic relationship in which the anorexic can identify and express feelings, experience the empathic, nonjudgmental understanding of another person, separate from a pathological family system, resolve hostile dependent attachment to parents, assuage primitive guilt, and engage in the trials of adolescent psychosexual development to enter adulthood with the beginnings of a firm, cohesive sense of self.
Dementia has seldom been subject to cross-cultural and cross-class analyses that localize the obviousness and meaningfulness of its pathology. Fieldwork with old persons and their families in four neighborhoods of Banaras, India, stratified by class, is presented to suggest the need for an anthropology of senility. The centrality of "hot brain"--of anger rather than memory as a fundamental index of senile difference--is explored through its differential construction across class and gender in these neighborhoods. The hearing of the angry voice is examined in relation to local knowledge about weakness, madness, and "sixtyishness" and to practices that maintain intergenerational difference through the construction of what is here termed a familial body.
One hypothesis for the reason a person might become a pathological gambler is that the individual initially experiences a big win, which creates a fallacious expectation of winning, which may then lead to persistent gambling despite suffering large losses. Although this hypothesis has been around for several decades, only one controlled empirical study has addressed it, and that study reported null results. In the present experiment, the authors tested the "big win" hypothesis by having 4 groups of participants with little to no experience gambling play a computer-simulated slot machine for credits that were exchangeable for cash. One group experienced a large win on the very 1st play. Another experienced a large win on the 5th play. A 3rd group experienced 2 small wins on the 2nd and 5th plays. No other winning outcomes were programmed. The 4th group never experienced a win. The authors observed a significant effect of group. Participants who experienced a large win on the 1st play quit playing the simulation earlier than participants who experienced a large win on the 5th play. These results appear to question the "big win" as an explanation for pathological gambling. They are more consistent with a behavioral theory of gambling behavior. The present study should also promote the use of laboratory-based research to test long-standing hypotheses in the gambling literature.
AIM: To explore whether polymorphisms of the CYPIA1 and GSTM1 genes are associated with susceptibility of stomach cancer. METHODS: A total of 102 stomach cancer cases and 62 healthy persons were diagnosed by pathology in 1998-2000 in the Qilu Hospital of Shandong University. Gene polymorphisms were detected by the PCR using sequence-specific primers. Data analysis of the case-control study was carried out using the unconditional logistic method. RESULTS: After adjustment for age, sex, educational levels, and occupation, the risk factors for stomach cancer were shown to be smoking, Helicobacter pylori (H pylori), and presence of the CYPIM G/G and GSTM1 O/O genotypes. Interaction was observed between the combined genotypes of either CYPIA1 G/G and GSTM1 O/O or H pylori infection, or GSTM1 O/O and H pylori infection or smoking. CONCLUSION: Polymorphisms of the CYPIA1 and GSTM1 genes, H pylori infection and smoking are related to susceptibility to stomach cancer.