Towards a cognitive model and measure of dissociation

Dissociation comprises a range of psychological processes, which have largely been the subject of psychodynamic discussion. Dissociative phenomena are for the most part unaddressed by cognitive theorists. Current measures are atheoretical and our understanding of dissociation has been hampered by the absence of clear psychological models. This paper describes a new cognitive model of dissociation and the development and validation of a theoretically based measure-the Wessex Dissociation Scale (WDS). The WDS has adequate internal consistency, shows convergent validity with the Dissociative Experiences Scale (DES-II), and is equivalent to the DES-II in its associations with severe psychopathology. However, the WDS has some advantages over the DES-II, in that it is sensitive to milder manifestations of dissociation, demonstrating links to less severe pathologies. The findings described here provide preliminary support for the usefulness of the cognitive model, and the varied consequences of dissociative processes. The clinical and research utility of the model and the scale are discussed.     

Metabolic response to feeding in weight-losing pancreatic cancer patients and its modulation by a fish-oil-enriched nutritional supplement

Weight-losing patients with advanced cancer often fail to gain weight with conventional nutritional support. This suboptimal response might be explained, in part, by an increased metabolic response to feeding. It has been suggested that eicosapentaenoic acid (EPA) can modify beneficially the metabolic response to cancer. The aim of the present study was to examine the metabolic response to feeding in cancer and the effects of an EPA-enriched oral food supplement on this response. A total of 16 weight-losing, non-diabetic patients with unresectable pancreatic adenocarcinoma and six healthy, weight-stable controls were studied by indirect calorimetry in the fasting and fed states. Body composition was estimated by bioimpedence analysis. Cancer patients were then given a fish-oil-enriched nutritional supplement providing 2 g of EPA and 2550 kJ daily, and underwent repeat metabolic study after 3 weeks of such supplementation. At baseline, resting energy expenditure whether expressed per kg body weight, lean body mass or body cell mass was significantly greater in the cancer patients compared with controls. Fat oxidation was significantly higher in the fasting state in cancer patients [median 1.26 g.kg(-1).min(-1) (interquartile range 0.95-1.38)] than in controls [0.76 g.kg(-1). min(-1) (0.62-0.92); P<0.05]. Over the 4 h feeding period, changes in insulin and glucose concentrations in cancer patients suggested relative glucose intolerance. In response to oral meal feeding, the percentage change in the area under the curve of energy expenditure was significantly lower in the cancer patients [median 7.9% (interquartile range 3.4-9.0)] than in controls [12.6% (9.9-15.1); P<0.01]. After 3 weeks of the EPA-enriched supplement, the body weight of the cancer patients had increased and the energy expenditure in response to feeding had risen significantly [9.6% (6. 3-12.4)], such that it was no different from baseline healthy control values. Similarly, fasting fat oxidation fell to 1.02 g. kg(-1).min(-1) (0.8-1.18), again no longer significantly different from baseline healthy control values. While weight-losing patients with advanced pancreatic cancer have an increased resting energy expenditure and increased fat oxidation, the energy cost of feeding is, in fact, reduced. Provision of a fish-oil-enriched nutritional supplement results in some normalization of the metabolic response in both the fasted and fed states, in association with an improvement in nutritional status.     

Does elevated cardiac troponin I in patients with unstable angina predict ischemia on stress testing?

To help guide physicians in their evaluation of patients with acute coronary syndromes, we investigated whether elevated cardiac troponin I in patients presenting with unstable angina predicts ischemia on stress testing. Elevated cardiac troponin I in patients who present with chest pain and normal creatine kinase levels is associated with ischemia on stress testing, as well as with future cardiac events.     

Orbital-facial complications of sinusitis in children

Although complications of sinusitis in children have lessened remarkably since the advent of antibiotics, nevertheless they still occur. In a 25-year period at the Hospital for Sick Children, 6,770 patients with the diagnosis of sinusitis were reviewed and 159 of these had orbital-facial complications. Surgical intervention was necessary in 17 to prevent more serious complications. Although there were no deaths in non-malignant disease, two patients developed permanent optic atrophy, presumably because of delayed surgical drainage. On occasion, malignant disease may simulate inflammatory processes.     

Clotrimazole inhibits the recombinant human cardiac L-type Ca2+ channel alpha 1C subunit

1. Clotrimazole (CLT) is an antimycotic agent with a potential role in the treatment of cancer. Whole-cell patch clamp recordings and Fura-2 AM fluorescence measurements were used to investigate the inhibition by CLT of recombinant human cardiac L-type Ca2+ channel alpha 1C subunits, stably expressed in human embryonic kidney (HEK 293) cells. 2. CLT (100 nmol l-1 to 25 mumol l-1) reduced Ca2+ channel currents in a concentration-dependent manner. Inhibition was neither use- or voltage-dependent. The effects of CLT were rapid and maximal effects were attained within 3 min. Application of CLT also caused an acceleration of apparent Ca2+ channel current inactivation. 3. Basal current density and the degree of inhibition due to CLT were not significantly altered by pretreating cells with 3 mmol l-1 1-aminobenzotriazole for 1 h, or by dialysing cells for 10 min with 2 mmol l-1 alpha-napthoflavone via the patch pipette, suggesting that the inhibitory action of CLT was not due to inhibition of cytochrome P-450. 4. CLT (10 mumol l-1) did not influence [Ca2+]i, as determined by Fura-2 AM fluorescence measurements. 5. Dialysing cells for 10 min with the non-specific serine/threonine kinase inhibitor H-7 (10 mumol l-1) was without effect on basal current density or on the inhibitory response to 10 mumol l-1 CLT, indicating that CLT is not acting via an indirect effect on these kinases. 6. These data suggest that CLT exerts a direct blocking effect on the alpha 1C subunit at therapeutic concentrations. This effect may explain the abbreviation of the action potential duration by CLT observed in cardiac myocytes.     

Normalized pediatric organ-absorbed doses from CT examinations

Absorbed doses to the bone marrow, gonads, thyroid, eyes, breast, and skin from CT examinations of the head, chest, abdomen, and torso were measured in a phantom mimicking an average 6-year-old child. The doses were normalized to the CT dose index measured at the central position of a standardized cylindrical phantom, to allow approximation of organ-absorbed doses for similar scanners for which the CT dose index has been measured. Estimating organ-absorbed doses associated with CT examinations of children is necessary to evaluate the relative risks of carcinogenesis associated with radiation exposure of a particular organ. The risks from a particular CT examination depends on the patient's age because the geometric configuration of the organs (e.g., marrow distribution) changes over time and will, therefore, affect the scatter dose to the organs.