‘Entopy’: local allergy paradigm

Cite this as: D. G. Powe, A. J. Bonnin and N. S. Jones, Clinical & Experimental Allergy, 2010 (40) 987–997. Allergy is defined as an immediate hypersensitivity type I immunological disease, which can be IgE or non‐IgE driven, and in the latter case may be antibody or cell mediated. Atopy is a term used to describe individuals with a genetic predisposition for developing IgE‐mediated allergic disease. But more recently, it has become evident that IgE‐mediated disease can occur in non‐atopic subjects. While it is now generally accepted that mucosal local IgE has a role in the expression of atopic allergic disease, the concept of ‘local allergy’ in non‐atopic subjects has been proposed, with the term ‘entopy’ given to this condition. Although there is increasing evidence supporting this paradigm, entopy is only applicable to a proportion of non‐atopic patients, suggesting that other disease mechanisms exist to explain non‐atopic disease. This review considers the evidence for local mucosal allergy in atopic and non‐atopic individuals with an emphasis on diseases affecting the upper airways and eye. Furthermore, the diagnosis, treatment and relationship between local allergy and conventional (systemic) allergy are discussed, and alternative disease mechanisms predominantly involving antibodies or their sub‐components (free light chain Igs) are postulated to explain the ‘entopy’ paradigm. This review is intended to provide an improved understanding of the mechanisms and causes of local mucosal hypersensitivity.     

Solid pseudopapillary tumor of the pancreas: ‘Experiences’ and ‘Lessons’ at a tertiary‐care oncology center

Solid pseudopapillary tumor of the pancreas (SPT) is a rare and fascinating entity of elusive histogenesis and unpredictable biology. It has a peculiar proclivity to afflict young females and involve the pancreatic body‐tail region. Cytology diagnosis of these rare neoplasms remains a challenge. We analyzed the cytology features of all SPT cases diagnosed on fine needle aspiration cytology (FNAC) from 2003 to 2009 along with their histopathology slides. Nineteen consecutive cases were diagnosed as SPT on FNAC. Fifteen out of nineteen cases were confirmed as true SPT on histopathology. Amongst the true SPT, all except one occurred in females. Age ranged from 14 to 50 years. Pseudopapillae bearing stout branches terminating in bulbous tips and enclosing transgressing vessels, separated from a collar of tumor cells by a clear zone of myxohyaline coat were pathognomonic of SPT. Singly dispersed monomorphic tumor cells with bland chromatin formed the second diagnostic component of SPT. Nuclear grooves and hyaline globules were in addition helpful in segregating SPT from its close differentials. In four cases diagnosed as SPT on FNAC, histopathology revealed a different final diagnosis (one case each of paraganglioma, extragastrointestinal stromal tumor, metastatic papillary renal cell carcinoma and inflammatory myofibroblastic tumor). Conversely, one case of SPT had been erroneously diagnosed as neuroendocrine tumor on FNAC. Six cases (40%) developed metastasis; commonest site being liver. In conclusion, cytology in conjunction with clinico‐radiologic findings plays a key role in making a correct diagnosis. Awareness of unique cytomorphological features is important in distinguishing this tumor from its diverse mimics. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

The (Body‐) ‘Thing’ Phenomenon and Primitive States of Being: ‘The Words to Say It’

Using Marie Cardinal's autobiographical novel The Words to Say It (1975), I explore how a somatic disturbance mysteriously located in utero represents an ‘après‐coup’, a second time experience of ‘what is already there’. The titles of both the book and this paper suggest that words hold a transformative power – an emotional re‐education for the fragmented subject. The ‘Thing’ refers on the one hand to the author's distressing illness: her continuous menstrual bleeding, for which there is no medical explanation. In order not to succumb to her ‘madness’, Marie decides to start psychoanalysis. From being utterly prostrated in darkness, Marie painfully remembers, repeats and reconstructs a piece of her early history (a ‘truth’) she had forgotten. Eventually, as the flow of words replaces the flow of blood, Marie ‘learns to name her ghost’ and is rewarded with a new sense of ‘self’. On the other hand, the ‘thing’ refers to the Freudian concept of thing‐presentation and word‐presentation. It concerns the processes by which an unconscious ‘thing’ which couldn't be symbolized becomes conscious once represented in words. The paper is inspired by French psychoanalysis.     

Pacific Populations,Metabolic Disease and ‘Just‐So Stories’: A Critique of the ‘Thrifty Genotype’ Hypothesis in Oceania

Pacific populations have long been observed to suffer a high burden of metabolic disease, including obesity, type 2 diabetes and gout. The ‘Thrifty Genotype’ hypothesis has frequently been used to explain this high prevalence of disease. Here, the ‘Thrifty Genotype’ hypothesis and the evolutionary background of Pacific populations are examined. We question its relevance not only in the Pacific region but more generally. Not only has the hypothesis not been explicitly tested, but most archaeological and anthropological data from the Pacific fundamentally do not support its application.     

When ‘Let's Pretend’ Goes Wrong: Failed Transitions

This paper is about the work of Françoise Dolto, a pioneering French child psychoanalyst, focusing on her understanding of separation, from the first major separation from the womb, through different stages in infancy and childhood. Her notion of ‘castration’ and ‘failed castrations’ is described and illustrated by the case history of a young patient whose transitions failed in the face of a traumatic family history. Françoise Dolto's work complements that of her contemporary Donald Winnicott. The paper explores some of the similarities and differences in their work.     

‘Poor me’ versus ‘Bad me’ paranoia: The association between self‐beliefs and the instability of persecutory ideation

Objectives. To investigate whether different self‐attributes would be associated with different degrees of deservedness of persecution in a clinical paranoid sample. Background. Some studies have shown differences between the self‐esteem (SE) of individuals with ‘Poor Me’ (PM) and ‘Bad Me’ (BM) paranoia ( Bentall et al., 2009 ; Chadwick, Trower, Juusti‐Butler, & Maguire, 2005 ). Most studies investigating this relationship have employed a cross‐sectional design, precluding the investigation of changes over time. Methods. In the cross‐sectional part of the study, 45 clinical participants and 25 controls were assessed in terms of paranoia, deservedness of persecution, SE, self‐discrepancies, daily events, and coping strategies. In the longitudinal part of the study, the clinical group was re‐assessed over a period of another 2 days, in order to study changes in these variables. Results. At baseline, there were no differences between the SE of the two paranoia presentations, which was significantly lower than the controls’. However, the paired‐samples repeated analysis found the SE of individuals when in a PM presentation was higher than when they were BM. Only BM paranoia was found to be associated with higher self‐ideal:self‐actual self‐discrepancies than the other groups. The longitudinal analysis indicated that, having been PM and having low SE at the previous assessment day made it more likely that individuals would be in BM subsequently. No differences in causal attributions made for ecological events were found between the groups. Higher SE was found to be more likely when individuals coped with adversities by using social support. Conclusions. Both deservedness of persecution and self‐views appear to be unstable in individuals with paranoia and to change consistently over time, a finding which is in keeping with Bentall et al.'s (2001) dynamic model of paranoia.     

‘THOUGHT DISORDER’: A DISTINCT PHENOMENOLOGICAL CATEGORY?

ABSTRACT A meditation on the nature of thought disorder, including a review of aspects of Bion's Grid and a celebration of Rameau's Nephew.