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The Authors, after a brief review of the literature concerning the congenital fistulae and cysts of the nasal dorsum with special regard to the etiology, pathology, diagnosis and therapy, report a personal case of such fistulae in a 15 year old male. They stress importanct, for an accurate diagnosis, of radiography and fistulography and reccomend, radical surgery.
OBJECTIVE: To evaluate the quality of referral from Primary Care to Mental Health and its relationship to the illness referred. DESIGN: A descriptive retrospective study over 4 years on the quality of the process. SETTING: Mental Health Centre II in the Autonomous Community of Murcia. PATIENTS: 209 patients referred by three Primary Care teams. MEASUREMENTS AND MAIN RESULTS: 91.4% of patients (C.I. 95%: 100%, 81.1%) were accepted with a referral report. 97.9% (C.I. 95%: 100%, 87.8%) presented a reason for psychiatric consultation. The report included the clinical history of the illness in 58.1% of cases (C.I. 95%: 70.3%, 45.9%); a diagnostic opinion was given in 79.6% (C.I. 95%: 91.1%, 68%); and 37.2% (C.I. 95%: 49.3%, 25%) were referred with a request for a specific consultation. 68.4% of the referrals (C.I. 95%: 81.8%, 54.9%) coincided with the Mental Health diagnosis. It was observed that among the most commonly referred pathologies: anxiety disorders (31.6%), affective (28.8%), personality (7.7%), psychotic (5.3%), and adaptive disorders (5.3%); diagnoses were commonly made for affective or anxiety disorders (p < 0.0001); the specific cause of referral of anxiety disorders was recorded (p < 0.01); and in cases of psychotic and personality disorders, the diagnoses did not coincide (p < 0.001). CONCLUSIONS: Referral to Mental Health can be improved, fundamentally by sending a report which includes the clinical history and the reason for referral. It is common to express a diagnostic opinion on affective and anxiety disorders, to note a specific reason for referral in the case of anxiety disorders and not to specify personality and psychotic disorders.
We describe 2 cases of diffuse fasciitis with eosinophilia (DFE) associated with prolonged exposure to the industrial solvent trichloroethylene (TCE). The medical and personal histories, examinations, and laboratory and pathological investigations were reviewed and summarized. The 2 case reports, representing the first and 2nd cases of DFE associated with TCE, were compared with 8 reported cases of systemic sclerosis associated with TCE and suggest a direct association between TCE exposure and the development of fasciitis (DFE).
Ageing constitutes a risk factor for magnesium deficit. Primary magnesium deficit originates from two aetiological mechanisms: deficiency and depletion. Primary magnesium deficiency is due to insufficient magnesium intake. Dietary amounts of magnesium are marginal in the whole population whatever the age. Nutritional deficiencies are more pronounced in institutionalized than in free-living ageing groups. Primary magnesium depletion is due to dysregulation of factors controlling magnesium status: intestinal magnesium hypoabsorption, reduced magnesium bone uptake and mobilization, sometimes urinary leakage, hyperadrenoglucocorticism by decreased adaptability to stress, insulin resistance and adrenergic hyporeceptivity. Secondary magnesium deficit in ageing largely results from various pathologies and treatments common to elderly persons, i.e., non-insulin dependent diabetes mellitus and use of hypermagnesuric diuretics. Magnesium deficit may participate in the clinical pattern of ageing, particularly in neuromuscular, cardiovascular and renal symptomatologies. The consequences of hyperadrenoglucocorticism-the simplest marker of which is non-response to the dexamethasone suppression test-may include immunosuppression, muscle atrophy, centralization of fat mass, osteoporosis, hyperglycaemia, hyperlipidaemia, atherosclerosis, and disturbances of mood and mental performance through accelerated hippocampal ageing particularly. It seems very important to point out that magnesium deficit and stress aggravate each other in a true 'pathogenic vicious circle', particularly in the stressful state of ageing. The importance of magnesium deficit in the aetiologies of insulin resistance, and the adrenergic, osseous, oncogenic, immune and oxidant disturbances of ageing is still uncertain. Oral physiological magnesium supplementation (5 mg Mg/kg/d) is the best diagnostic tool for establishing the importance of magnesium deficiency. Too few open and double blind studies on the effects of the treatment of magnesium deficiency and of magnesium depletion in geriatric populations have been done. Further study is necessary to assess the true place of magnesium deficit in the pathophysiology of ageing.
Lung function and bronchial response to methacholine were studied in 47 young adults who had had childhood asthma, and after a period of 14-21 years, showed a different clinical evolution. At present, these subjects have been classified in four clinical groups: asymptomatic, rhinitic, asthmatic only due to exercise, and asthmatic. The same study was performed in 23 healthy individuals without personal histories of respiratory or allergic pathology. We found low spirometric basal values in both the asthmatic group (FEV1 and FEF25-75) and in the group with asthmatic responses to exercise (FEF25-75). No significant differences were found among asymptomatic, rhinitic, and control groups. While airway hyperreactivity was observed in patients who still had asthma, the bronchial response to methacholine in asymptomatic and rhinitic groups was not different from the control group. We conclude that both lung function and bronchial response to methacholine in most of the adults who had asthma in infancy and had been without asthmatic symptoms for many years are similar to those observed in the general population.
We have known for decades that essential hypertension significantly contributes to many physical diseases. In most cases, hypertension results from a person's perception of stress producing events or situations. According to Greenberg, when a person is confronted by a situation or an event, the person must perceive it as either positively or negatively stressful. If it is perceived as positively stressful, a series of psychological reactions are incurred followed by physiological reactions. If these psychophysiological manifestations persist, the person is then faced with possible pathological conditions. This study attempted to support the hypothesis that people with hypertension should be able to benefit from biofeedback and relaxation techniques. Using these techniques, they will be better able to recognize and understand perceived stressful events or situations and will therefore act appropriately. The purpose of this study is to examine the effects of biofeedback, relaxation and the combination of both techniques on medically diagnosed hypertensive patients. More specifically, the study examined the following questions: What is the clients' ability to lower their blood pressure using biofeedback, relaxation and the combination of both techniques? To what capacity can clients reduce their biofeedback and relaxation training programme? Twenty-three males, aged 40 to 70 years (M = 54 years), who were registered with a cardiovascular disease prevention and rehabilitation centre, volunteered to participate in this study. For five weeks, clients trained Tuesdays and Thursdays, one hour per session. Compliance to the training programme was respected by using only those clients who had missed fewer than three of the sessions. The results showed little statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)
102 patients were divided into 3 groups: epileptics, psychotics and epileptics with psychotic symptoms. All had long been monitored for a number of clinical and laboratory parameters. Though different in many respects, all share states of sudden dysphoria, cacophoria, panic anxiety, horror, and EEG (stereo-EEG, too) signs of epileptic or other gross anomalies, often correlated to those affective disorders. Attacks of dysphoria, epilepsy, and psychosis come spontaneously and in response to biological (hypoglycemia, sleep deprivation, alcohol, menses) or psychosocial stimulation (agitation, quarrels, fear of redundancy, psychic trauma). These states (attacks, dysphoria, "neurotic" or even psychotic episodes) often provoke one another. -Calling this syndrome epileptosis, we believe its mechanism is due to lesions of the limbic and brainstem modulation systems. At the start of the process there is an epileptic focus in the amygdalo-hippocampal complex (AHC) which in itself can trigger simple or complex partial paroxysm but also-by means of electric stimulation of the AHC-states of dysphoria, anxiety, and psychotic hallucinations. Besides, a form of pathological learning develops in premorbid "hypersensitive" personality which can be put down to associative learning and to Overton's phenomenon of "state-dependent retention of learned responses". This may give rise to mutual stimulation where epileptic focal activity in AHC can provoke dysphoria while an external psychosocial situation can trigger epileptic activity there, too (AHC). Since there need not always be mydriasis (though other vegetative signs such as tachycardia, tachypnoea, nausea, blush and others are frequent) or unconsciousness, and some psychomotor manifestations may be out of the ordinary, and scalp EEG may be normal, such patients are often regarded as "hysterics" or malingerers.
The differential diagnosis of psychiatric symptoms in encephalitis, especially in the early phase of the disease may be very difficult. It is particularly hard to distinguish it from the classic psychosis. The diagnostic problems have been presented on the basis of analysis of two case reports of the acute encephalitis in young persons. The presence of fever and pathological changes in the CSF were the most important indicators that helped to establish the diagnosis of encephalitis during the phase of acute psychopathological disorders.
Ageing constitutes a risk factor for magnesium deficit. Primary magnesium deficit originates from two etiological mechanisms: deficiency and depletion. Primary magnesium deficiency is due to insufficient magnesium intake. Dietary amounts of magnesium are marginal in the whole population whatever the age. Nutritional deficiencies are more pronounced in institutionalized than in free-living ageing groups. Primary magnesium depletion is due to dysregulation of factors controlling magnesium status: intestinal magnesium hypoabsorption, reduced magnesium bone uptake and mobilisation, sometimes urinary leakage, hyperadrenoglucocorticism by decreased adaptability to stress, insulin-resistance and adrenergic hyporeceptivity. Secondary magnesium deficit in ageing largely results from various pathologies and treatments common to elderly persons: i.e. non insulin dependent diabetes mellitus and use of hypermagnesuric diuretics. Magnesium deficit may participate in the clinical pattern of ageing: mainly neuromuscular, cardiovascular and renal symptomatologies. The consequences of hyperadrenoglucocorticism--whose non response to dexamethasone suppression test appears the simplest marker--may concern immunosuppression, muscle atrophy, centralization of fat mass, osteoporosis, hyperglycemia, hyperlipidemia, atherosclerosis, disturbances in mood and mental performances through accelerated hippocampal ageing particularly. Treatment of magnesium deficiency requires simple oral physiological magnesium supplementation. Treatment of the different types of magnesium depletion leads to a more or less specific control of pathophysiological disturbances of the required magnesium substrate. Open and double blind studies on the effects of the treatments of magnesium deficiency and of magnesium depletions in geriatic populations are too scarce. Further study is necessary to assess the accurate place of magnesium deficit in the physiopathology of ageing.
The thesis of this paper is two-fold. First, it proposes that the psychic reality of the borderline patient evolves in a three-step process during the analytic treatment. These steps include: (i) experiencing and presenting disparate psychic states without the awareness of inherent contradictions, (ii) observing, acknowledging, and mending the splits responsible for these contradictions, and (iii) developing a capacity for feeling and accepting paradox, i.e. coexistence of multiple meanings at different levels of abstraction. Second, the author suggests that this three-step movement vis-à-vis the associative material takes place first within the analyst's reverie and then in the patient's psychic reality. The analyst's holding, unmasking, bridging and depth-rendering interventions (and the vicissitudes of identification) make the patient's advance possible. The author presents two clinical vignettes, highlighting these hypotheses and their technical implications. A vignette from the non-clinical realm of a mother's interaction with her children is also included in the hope of demonstrating a developmental 'Anlage' of the analyst's interventions outlined above. The paper concludes with the observation that the practising analyst also needs to traverse a 'simplicity-contradiction-paradox' sequence in his view of the divergent theoretical approaches to the analytic understanding and treatment of severe character pathology.
From 2 personal cases the authors present a pathological appraisal of appendicular mucoceles. They distinguish between a benign kind with an atrophic mucous membrane and a malignant type with a hyperplasic epithelium arranged in papillary and vegetating structures; this is a neoplasm with local malignancy. This variety remains the most liable to become a peritoneal pseudo-myxoma representing the most serious complication of the appendicular mucecele. Treatment of the mucocele, which consists in an appenicectomy or a right bemi-colectomy, usually yields good results provided operative rupture can be avoided. Contrarily the peritoneal pseudo-myxoma remains a serious disease with a disappointing treatment.
A clinico-epidemiologic prevalence survey was conducted in the sub-mountainous area of Northern Bohemia, which is distinguished by the highest proportion of aged people in Bohemian countries. It involved 6057 persons of the 70-79 age group, 1718 persons of the 80-89 age group and 139 persons of the 90+ group, plus control subjects in various other groups. In this study an attempt was made to find an effective measure of the presumed risk factors of pathologic aging in persons of the 70-105 age group. The data were analyzed by the method of coincidence of two parameters of binomial decomposition on the computer Odra. The quantity dependence of the signs was determined, and an index of the compound-risk factor of pathologic aging was calculated. When the numerical value of the index is lower than 56.9 +/- 4.36 for a group of males or 50.3 +/- 3.55 for a group of females, the probability is that a given person in those groups will survive to an advanced age. The total risk is higher for the male sex. Of considerable importance are the genetic burden, external environmental causes, harmful habits, certain "civilization" diseases, and other factors such as disturbed social contacts and defective nutrition.
After a report on the basic techniques and clinical significance of plasmapheresis, personal experience of the application of the technique on 6 patients with various pathologies is described. The overall results were satisfactory.
The authors describe the results of a comprehensive examination of 5 persons with chromosomal aberration (47, XYY) manifesting the signs of deviation from normal sexual behavior. The examined were shown to have common dysontogenesis that manifested itself by retardation of the biological basis of sexuality, psychosexual formation together with retardation of the mental processes on the whole. Whatever variants of deviations from normal sexual behavior the common feature was predominance in the libido structure of sadistic aims, that contributed to the revealing of aggressive sexual behavior. Material changes were discovered by radioimmunoassay in the function of the hypothalamohypophyseal and gonadal system in persons with the "YY syndrome". The levels of prolactin and luteinizing hormone along with the LH/FSH ratio appeared significantly elevated. Disorders were also identified in the hypothalamohypophyseal and thyroid system. It is assumed that the discovered changes influence the serotoninergic mechanisms by which aggressive and pathological sexual behavior is formed in such persons.
Nowadays, one hundred years following Charcot's death (1893), neurologists remember his original contributions in the field of neurological disorders. The aim of this work is to assess the extraordinary Charcot's ability to create new diseases outside the field of neurology, mainly in internal medicine and in geriatric disorders. A good way to evaluate his abilities is to compare the state of medical knowledge before and after Charcot. Before, "chronic rheumatic disease" was not distinguished from gout and shaking falsy was confused with other tremors occurring in the elderly. Among vascular cerebral diseases ("apoplexy"), physicians could not recognize those following a bleeding process from those induced by an ischaemic brain disease. After Charcot's papers, these various disorders were better known and well defined from their pathology, aetiology and mechanisms. According to his obsessive personality, Charcot liked classifying and labeling diseases. Some nosographic frameworks were nevertheless inappropriate. Thus, in the field of joint disorders, Charcot included in the same pathological entity ("chronic rheumatic disease") various arthropathies such as rheumatic arthritis and osteo-arthritis. In France, this mistake hindered the understanding of the mechanism of these diseases. Though Charcot made mistakes when he described new pathological disorders, these mistakes were of little consequence, compared to the importance of his main nosologic contributions. As a whole, Charcot's scientific methodology seemed to be accurate and successful.
Narcissistic vulnerability is a central feature of both normal and pathological adolescence. Examining the unfolding of self-esteem regulation against a developmental background, the author proposes a framework to differentiate normal adolescent vulnerability from pathological narcissistic regulation and narcissistic psychopathology. Normal adolescents achieve a partial disengagement from their internalized parents without finding themselves bereft of limit-setting and direction-giving capacities or unable to maintain basically good relationships with both their real and their intrapsychic parents. Normal adolescents can construct an ideal that guides their transition into adulthood. In pathological narcissism, by contrast, youngsters crystallize their reliance on an omnipotent sense of self, refuse to acknowledge their shortcomings and vulnerabilities, project onto others disowned self-experiences, and demand public affirmation of their illusory power. Multiple developmental factors transact, in different proportions, to produce the specific features of narcissistic personality disorder. Several clinical subtypes of narcissistc pathology can be distinguished, representing the predominance of particular sets of developmental forces. In the histrionic-exhibitionistic type, the predominant features are the organization of the sense of self around the adolescent's talents or beauty, coupled with an ongoing need for admiration and attention from others. They feel exhilarated when they find confirmation but become spiteful or feel crushed when ignored. Ruthless psychopathic adolescents dissociate and deny pain, helplessness, and vulnerability; rigidly attempt to maintain an illusion of control and invulnerability; and ruthlessly exploit, intimidate, and manipulate others. They scan constantly for threats or blame and are haunted by the expectation of attack. Self-victimizing, masochistic youngsters organize their sense of self around the experience of being victimized. Their apparent helplessness, however, feeds a secret conviction of power and superiority.
Diagnostic computer-aided transesophageal cardiac pacing was used to examine 45 patients with epileptic seizures of different genesis, who had no signs of cardiac rhythm derangement. 28 patients with heart arrhythmias and 30 practically healthy persons served as control groups. 64.44% of the patients with epileptic seizures manifested different types of latent pathology in the heart conduction system. Among the practically healthy persons, the analogous parameter was 10%, with premature heart beats being recorded only in single cases. 60.71% of the control group patients with heart arrhythmias showed alterations of the epileptic type demonstrated by the EEG. It is concluded that there is a close relationship between the epileptic process and pathology of the heart conduction system. Of definite role in this chain is the factor of the focal nature of the epileptic impairment, particularly the involvement of the ++temporo-diencephalic structures and ++limbico-reticular complex.
The pelvic abscesses as complication of surgical operations or various pathologies is a delicate clinical situation because of the possible and unexpected evolution into a settic shock with a high risk of death. The authors report their personal experience of 16 cases undergone surgical treatment. They underline the importance of an early diagnosis, of a control of the patient general conditions with a specific antibiotic therapy, of the possibility to treat this pathology in a percutaneous way with the help of radiologic techniques or eventually by surgery.