The dialogical self in psychotherapy for persons with schizophrenia: a case study

Schizophrenia often involves a profound experience of one's identity as diminished, which complicates adaptation to the demands of daily life. Within a backdrop of dialogical self-theory, we provide a report of an individual psychotherapy over the course of 4 years that assisted a patient suffering from schizophrenia to move from a state in which few aspects of self were available for internal or external conversation to one in which there was greater accessibility of multiple aspects of self, leading to richer dialogues, improved function, and a better quality of life. It is suggested a primary intervention of the therapist was continuously to offer the client a view of himself that invited him to experience himself in a plausible manner shared with and listened to by another.     

Usefulness of FDG-PET to diagnose intravascular lymphoma with encephalopathy and renal involvement

Intravascular lymphoma (IVL) is a rare subtype of extranodal diffuse large B-cell lymphoma. It is characterized by proliferation of neoplastic Lymphoid cells almost exclusively within the lumina of small blood vessels. It can affect virtually every organ system. Due to its rarity and its diverse and heterogeneous clinical presentation, diagnosis is difficult and often made post-mortem. When diagnosed early, it is, however, potentially treatable. We present a young woman with longstanding constitutional symptoms, positive antinuclear antibody, elevated LDH levels and rapidly progressive encephalopathy. FDG-PET scan showed intense uptake in the renal cortex, which prompted us to perform a kidney biopsy which was compatible with IVL. The value of PET in establishing the diagnosis of this rare disease will be discussed.     

Magnetic resonance imaging of renal transplants: its value in the differentiation of acute rejection and cyclosporin A nephrotoxicity

The purpose of this study was to determine the value of magnetic resonance imaging (MRI) in the differentiation of acute rejection and cyclosporin A nephrotoxicity in renal transplant kidneys. Fifty-six magnetic resonance examinations in 46 patients were prospectively and independently evaluated by two radiologists. MRI was performed with a 0.5 T superconducting scanner (Gyroscan S5, Philips) applying both T1 and T2 weighted pulse sequences. Biopsies were performed in 22 cases and histology was reviewed. Fifteen normally functioning transplant kidneys and 41 kidneys with graft dysfunction due to cyclosporin A nephrotoxicity, acute rejection, chronic rejection or acute tubular necrosis were studied. Absence or reduction in cortico-medullary demarcation proved to be a sensitive, but non-specific indicator of parenchymal disease. In cases of cyclosporin A nephrotoxicity the allograft was diagnosed as being normal in 90%. The magnetic resonance appearance of acute rejection may be very similar to that of the combination of acute rejection and cyclosporin A nephrotoxicity, chronic rejection or acute tubular necrosis. However differentiation between acute rejection and cyclosporin A nephrotoxicity was possible according to the following statistical data: sensitivity 100%, specificity 75%, positive predictive value 86%, negative predictive value 100%, accuracy 90%.     

Rating data are underrated: Validity of US expectancy in human fear conditioning

Background and objectivesHuman fear conditioning is widely regarded as one of the prime paradigms for the study of fear and anxiety disorders. We provide an evaluation of a commonly used subjective measure in the human fear conditioning paradigm, namely the US-expectancy measurement.MethodsWe assess the validity of US-expectancy with respect to conditions of pathological fear and anxiety using four established criteria for scrutiny of a laboratory test or model (i.e., face validity, diagnostic validity, predictive validity, construct validity).ResultsArguably, there is sufficient evidence for the face validity, diagnostic validity, predictive validity and construct validity of the US-expectancy measure.LimitationsPresumed limitations of the US-expectancy measure, including its susceptibility to experimental demand and memory bias, are discussed.ConclusionsThe US-expectancy measure is a valuable measurement method that can be effectively used in research that aims to enhance our understanding of fear and anxiety disorders.     

Presenting signs and symptoms in multiple myeloma: High percentages of stage III among patients without apparent myeloma-associated symptoms

We studied the medical histories of 127 patients diagnosed with multiple myeloma included in a population-based registry of 945 patients with a paraprotein or multiple myeloma in the region of the Comprehensive Cancer Center West (CCCW). We defined patients not immediately diagnosed or delayed diagnosis as those patients in whom myeloma was not included in the initial differential diagnosis. We found that 37% belonged to this category. These patients more often had symptoms not associated with multiple myeloma. Since a surprising 51% of patients with delayed diagnosis turned out to have stage-Ill myeloma, the physician should be alert to the presence of this disease, despite the fact that co-morbidity may mask its presence.     

Understanding gastrointestinal perfusion in critical care: so near, and yet so far

An association between abnormal gastrointestinal perfusion and critical illness has been suggested for a number of years. Much of the data to support this idea comes from studies using gastric tonometry. Although an attractive technology, the interpretation of tonometry data is complex. Furthermore, current understanding of the physiology of gastrointestinal perfusion in health and disease is incomplete. This review considers critically the striking clinical data and basic physiological investigations that support a key role for gastrointestinal hypoperfusion in initiating and/or perpetuating critical disease.