The double-orifice tricuspid valve: a review

BACKGROUND AND AIM OF THE STUDY: Duplication of an atrioventricular valve is a rare congenital anomaly, with only single cases of double-orifice tricuspid valves (DOTV) having been identified. Because of its rarity, the clinical spectrum of this entity remains obscure. METHODS: A literature search was conducted using databases and search engines. In addition, the reference sections of all relevant articles were searched to identify additional cases. All cases reported until March 2006 were included. RESULTS: In total, 22 cases of DOTV were identified. The mean patient age was 21 years, and there was a male predominance. Autopsy was the leading mode of detection, followed by surgery and echocardiography. In cases where the functional status of the DOTV was specifically mentioned, pure regurgitation was found in 62.5%, and combined stenosis and regurgitation in 25%. In 12.5% of cases the valve function was normal. Additional congenital malformations were present in (72.7%) of cases (n = 16). CONCLUSION: The DOTV is a very rare congenital heart defect. The isolated occurrence of this condition seems extremely rare, and in most cases it is associated with other congenital cardiac malformations that determine patient outcome.     

H pylori infection causes chronic pancreatitis in Mongolian gerbils

AIM： To investigate whether chronic H pylori infection has the potential to induce pancreatitis in the Mongolian gerbil model, and whether it is dependent on an intact type Ⅳ secretion system. METHODS： Mongolian gerbils were infected with wild type （WT） H pylori type Ⅰ strain B128 or its isogenic mutant B128 △cag γ （defective type Ⅳ secretion）. After seven months of infection, H pylori was reisolated from antrum and corpus and Hpylori DNA was analyzed by seminested polymerase chain reaction （PCR）. Inflammation and histological changes were documented in the gastric antrum, corpus, and pancreas by immunohistochemistry. Cytokine mRNA, gastric pH, plasma gastrin, amylase, lipase, and glucose levels were determined.
RESULTS： The H pylori infection rate was 95%. Eight infected animals, but none of the uninfected group, developed transmural inflammation and chronic pancreatitis. Extensive interstitial fibrosis and inflammation of the pancreatic lobe adjacent to the antrum was confirmed by trichrome stain, and immuno-histochemically. Pro-inflammatory cytokine mRNA was significantly increased in the antral mucosa of all infected gerbils. In the corpus, only cytokine levels of WT-infected animals andthose developing transmural inflammation and pancreatitis were significantly increased. Levels of lipase, but not glucose or amylase levels, were significantly reduced in the pancreatitis group. H pylori DNA was detected in infected antral and corpus tissue,but not in the pancreas
CONCLUSION： H pylori infection is able to induce chronic pancreatitis in Mongolian gerbils independently of the type Ⅳ secretion system, probably by an indirect mechanism associated with a penetrating ulcer.     

A comparison of the clinical features of fibromyalgia syndrome in different settings

Background: The “funnel hypothesis” of fibromyalgia syndrome (FMS) assumes that the high levels of somatic and psychological symptoms reported by FMS‐patients are due to a selection bias of patients seeking for medical specialist care. We tested the hypothesis by comparing FMS‐patients from a general population sample and different clinical settings. Methods: From a cross‐sectional survey of a representative sample of the German general population, persons meeting FMS‐criteria were selected. Consecutive in‐ and outpatients from German rheumatology, pain medicine, psychosomatic medicine and integrative medicine settings with established or initial diagnosis of FMS were recruited. FMS was diagnosed in all samples by the survey criteria of the regional pain scale. Somatic symptom intensity was measured by 13 items of the Patient Health Questionnaire PHQ 15, depressed mood by the 9‐items PHQ 9. Results: 96 persons of the general population, 86 of the rheumatology, 80 of the pain medicine, 69 of the psychosomatic medicine and 58 of the integrative medicine setting were included into the comparison. Patients of the clinical settings reported more pain sites and more somatic and depressive symptoms than FMS‐persons of the general population. Patients of the different clinical settings did not differ in the number of pain sites and the intensity of depressive and somatic symptoms. Conclusions: We found a “funnel” between FMS‐persons of the general population and FMS‐patients of clinical settings, but not between patients of different levels of care. Patients contacting the health care system did not differ in clinical features.     

What Happens in Therapy with Sexual Offenders? A Model of Process Research

This paper presents two studies (one single case and one comparative study) examining change processes within individual therapy sessions as well as during the course of treatment. The Therapeutic Cycle Model (TCM), developed for general psychotherapy to objectify change events in the course of psychotherapies, is applied to transcribed tape recordings of therapy sessions with sexual offenders. The TCM focuses on emotional experience and cognitive mastery and uses computer assisted text analysis. In addition to the TCM approach clinical ratings are used as independent criteria. The predicted relationship between the phases of the TCM and scores on the respective scales of the clinical ratings were supported.     

Psychiatric comorbidity in medical inpatients - prevalence and effect on the length of stay

In the course of a year the prevalence of psychiatric comorbidity as well as the effect of psychiatric comorbidity on the length of stay on two internal medical wards we investigated. When examined by separate methods, the prevalence of psychiatric comorbidity reached 36 % (ICD-10 diagnosis) in a sample of 511 medical inpatients of a university hospital. The study shows that patients with psychiatric comorbidity have a significantly longer length of stay - up to 8.2 days compared with inpatients with mere internal diagnosis. This association was not influenced by the length and the severity of the illness. The findings lead to the conclusion that psychiatric comorbidity is a central contributor to one of the most important factors of medical costs - the length of stay.     

Multiplex DNA short tandem repeat analysis. A useful method for determining the provenance of minute fragments of formalin-fixed, paraffin-embedded tissue

A tiny fragment of high-grade carcinoma was found in histologic sections and in the paraffin block of a benign cervical polyp from a patient with no clinical evidence of malignancy. Thus, it raised the suspicion of block contamination. No malignant tumor was processed the same day as the polyp; however, a similar tumor had been processed 6 days earlier. Multiplex DNA short tandem repeat analysis was applied to paraffin-extracted tissue samples obtained from the polyp, the suspected contaminant, the patient's additional cervical biopsy specimen, and the putative source of contamination. The results demonstrated that the suspected contaminant and the patient's cervical tissue could not have come from the same patient and that the suspected contaminant derived from the tumor processed earlier, without reasonable doubt. We hypothesize that this friable tumor escaped from cassettes into the processor and contaminated the polyp specimen. Multiplex DNA short tandem repeat analysis can be applied to determine the provenance of minute tissue samples in surgical pathology.