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PubMed2000

[Behavioral aspects of chronic pain syndromes].

The knowledge of biological pain mechanisms are not sufficient for the understanding of patients with chronic pain syndromes such as low back, cervicobrachial and muscle pain. Psychological and psychosocial aspects play important roles in the setting and perpetuation of symptoms. Mood and anxiety disorders, secondary gains such as early retirement and financial compensations, must all be acknowledged by the physician as possible contributors to the symptoms. Abnormal illness behavior may better characterize patients with chronic pain syndromes. Behavior observation, which is akin to medical practice, is therefore a powerful tool in the diagnosis and management of these syndromes. Physicians ought be very careful in not reinforcing the patients already strong organic convictions regarding their symptoms, avoiding making decisions based on patients complaints and alleged disabilities, and assigning poorly defined and disputable diagnosis labels. Society needs also to refrain from policies that encourage abnormal illness behaviors.

Chronic Disease↗
PubMed2005

Integrative analysis of gene expression patterns predicts specific modulations of defined cell functions by estrogen and tamoxifen in MCF7 breast cancer cells.

To explore the mechanisms whereby estrogen and antiestrogen (tamoxifen (TAM)) can regulate breast cancer cell growth, we investigated gene expression changes in MCF7 cells treated with 17beta-estradiol (E2) and/or with 4-OH-TAM. The patterns of differential expression were determined by the ValiGen Gene IDentification (VGID) process, a subtractive hybridization approach combined with microarray validation screening. Their possible biologic consequences were evaluated by integrative data analysis. Over 1000 cDNA inserts were isolated and subsequently cloned, sequenced and analyzed against nucleotide and protein databases (NT/NR/EST) with BLAST software. We revealed that E2 induced differential expression of 279 known and 28 unknown sequences, whereas TAM affected the expression of 286 known and 14 unknown sequences. Integrative data analysis singled out a set of 32 differentially expressed genes apparently involved in broad cellular mechanisms. The presence of E2 modulated the expression patterns of 23 genes involved in anchors and junction remodeling; extracellular matrix (ECM) degradation; cell cycle progression, including G1/S check point and S-phase regulation; and synthesis of genotoxic metabolites. In tumor cells, these four mechanisms are associated with the acquisition of a motile and invasive phenotype. TAM partly reversed the E2-induced differential expression patterns and consequently restored most of the biologic functions deregulated by E2, except the mechanisms associated with cell cycle progression. Furthermore, we found that TAM affects the expression of nine additional genes associated with cytoskeletal remodeling, DNA repair, active estrogen receptor formation and growth factor synthesis, and mitogenic pathways. These modulatory effects of E2 and TAM upon the gene expression patterns identified here could explain some of the mechanisms associated with the acquisition of a more aggressive phenotype by breast cancer cells, such as E2-independent growth and TAM resistance.

Breast Neoplasms↗
PubMed2005

Cisplatin is a DNA-damaging antitumour compound triggering multifactorial biochemical responses in cancer cells: importance of apoptotic pathways.

cis-diamminedichloroplatinum(II) (cisplatin) is among the most active antitumour agent used in human chemotherapy. The purpose of this review is to give an insight in several molecular mechanisms that mediate the sensitivity of cancer cells to this drug and to show how recent progress in our knowledge on some critical molecular events should lay the foundations of a more rational approach to anticancer drug design. Cisplatin is primarily considered as a DNA-damaging anticancer drug, mainly forming different types of bifunctional adducts in its reaction with cellular DNA. We will address the question of cellular activity disruption that cisplatin could cause through binding to more sensitive region of the genome such as telomeres. Cellular mechanisms of resistance to cisplatin are multifactorial and contribute to severe limitation in the use of this drug in clinics. They include molecular events modulating the amount of drug-DNA interaction, such as a reduction in cisplatin accumulation inside cancer cells or inactivation of cisplatin by thiol-containing species. Other important mechanisms acting downstream to the initial reaction of cisplatin with DNA, include an increase in adducts repair and a decrease in induction of apoptosis. Recently accumulating evidence suggest a role of the long patch DNA mismatch repair system in sensing cisplatin-damaged DNA and in triggering cell death through a c-Abl- and p73-dependent cascade; two other important pathways have been unravelled that are the mitogen-activated protein kinase cascade and the tumor suppressor p53. Several of these mechanisms underlying cisplatin resistance have been exploited to design new platinum derivatives. This issue will be covered in the present review.

Animals↗
PubMed1992

Factitious apraxia.

A case is described in which a patient had pseudoneurological symptoms that were present only upon direct observation or when the patient was in clinical test situations. The differential diagnosis of apraxia is discussed as well as clinical suggestions for evaluating patients with suspected factitious apraxia.

Adult↗
PubMed1993

The corpus callosum: normal fetal development as shown by transvaginal sonography.

OBJECTIVE: Detection of the corpus callosum in the developing fetus on sonograms usually is difficult. We determined the normal appearance and development of this structure during the second half of pregnancy, as shown on transvaginal sonograms. SUBJECTS AND METHODS: One hundred one fetuses were evaluated with transvaginal sonography between 18 and 42 weeks' gestation. The length of the corpus callosum and the thicknesses of the genu, body, and splenium were measured, and growth tables were produced. RESULTS: The corpus callosum was detected in 95% of cases and showed gradual enlargement during pregnancy; growth was linear, from nearly 17 mm in length at 18 weeks' gestation to 44 mm at term. The ratios of the length of the corpus callosum to the anteroposterior diameter of the brain remained relatively constant from 20 to 21 weeks' gestation to term. CONCLUSION: Transvaginal sonography can be used to visualize and measure the corpus callosum in the developing fetus. Data from this study may be useful as a reference for normal development of the corpus callosum.

Corpus Callosum↗
PubMed1994

The Recognition Memory Test in the assessment of memory impairment after financially compensable mild head injury: a replication.

The current investigation replicated the findings from a 1992 study by Millis. 20 subjects with claimed mild head injury who were seeking financial compensation obtained significantly lower scores on both subtests of the Recognition Memory Test than did 66 rehabilitation inpatients with documented moderate and severe traumatic brain injuries. The direct discriminant function derived by Millis was cross-validated on the current sample and yielded an improved over-all correct classification rate of 83%, with 85% and 82% of the mild and severe traumatic brain-injured subjects classified correctly, respectively. Over-all correct classification rate in the original study was 76%.

Adolescent↗
PubMed1998

Scratch density differentiates microsmic from normosmic and anosmic subjects on the University of Pennsylvania Smell Identification Test.

During assessment of smell function using the University of Pennsylvania Smell Identification Test, we observed that some persons with diminished smell perception seemed to perserverate in their attempts to release the odorant from the microencapsulated odorant strips. In this study we quantified the marked area of 1680 such strips from tests administered to 42 anosmics, normosmics, and microsmics. The density of pixels on the microencapsulated labels from the microsmic patients was greater than that from the other two groups, which did not differ significantly from one another. These data suggest (i) that persons with diminished olfactory ability attempt to increase the perceived intensity of the stimulus by marking the test's scent strips more vigorously and (ii) that the density of such marking may prove useful in detecting malingerers attempting to feign microsmia.

Aged↗
PubMed1999

Reproducibility of performance and certainty of judgment in maximal vs feigned muscular effort.

Detection of feigned muscular effort is a highly challenging topic in the medicolegal arena. Modern dynamometric methods have enabled a much higher accuracy in deciding whether the effort in question is indeed genuine or submaximal. Since in feigning the target, however, performance may fluctuate even within a single testing session, reproducibility cannot be assured. In actual claims, the statistical nature of certainty in proclaiming a feigned effort must be well understood by those involved in deciding the fate of a claim.

Deception↗
PubMed1999

Conceptualizing a better understanding of diagnosing and treating posttraumatic stress disorder: a review of two case studies.

Clinical and epidemiological studies have supported the belief that human beings exposed to stressful life events are vulnerable to the symptomatology consistent with posttraumatic stress disorder (PTSD). However, early detection of symptoms consistent with PTSD oftentimes does not occur within the medicolegal arena. The importance of an early and accurate diagnosis is emphasized. Fortunately, the diagnosis of PTSD has become more clearly conceptualized in the DSM-IV criteria. Many of the characteristics consistent with this diagnosis are measured through the use of relatively recently developed and refined psychometric measures including the Posttraumatic Stress Diagnostic Scale, the Trauma Symptom Inventory, and the Personality Assessment Inventory-2. Additional measures including the Computerized Response Bias Test, the Word Memory Test, and the Validity Indicator Profile can detect exaggeration of symptoms without using specific tests for symptom validity. These measures, as well as biochemical determinations, are reviewed and presented along with the over-all structured clinical interviews and mental status examinations of two patients for a better understanding of the multimethod approach which establishes the reliability of the PTSD diagnosis.

Adult↗
PubMed1991

A Fake Bad Scale on the MMPI-2 for personal injury claimants.

This paper presents a scale for using the Minnesota Multiphasic Personality Inventory-2 for the detection of malingerers in personal injury claims. Data are reported for personal injury claimants and for medical outpatients simulating emotional distress caused by motor vehicle accidents, industrial stress, and toxic exposure. Criterion problems are discussed. The answers and scored directions are presented in an appendix to the paper.

Accidents, Traffic↗