Corrective Experiences of Psychotherapists in Training

Although the concept of corrective experiences (CEs) is usually linked to the process of change in psychotherapy patients, we investigated them in the professional development of therapists‐in‐training. Inasmuch as psychotherapy is a relational process, it is important to look closely at how therapists reach the position of a competent partner in corrective experiencing. In this study, we interviewed 10 therapists‐in‐training undergoing their own training therapy. Responses to these semistructured interviews were analyzed using a computer‐assisted grounded theory method. The 499 first‐level categories were grouped into 5 main themes: therapist characteristics, therapist technical interventions, therapist relational interventions, relationship experience, and outcome experience. Two core categories representing corrective experiencing were (a) unexpected unconditional support from and trust in their own therapist and (b) unexpected confrontation and limitation with their therapist as well as awareness of self–other boundaries. Results are discussed in the broader context of the CE literature, relational theory, and relational practice.     

An unusual case of Plasmodium vivax malaria monoinfection associated with crescentic glomerulonephritis: a need for vigilance

Plasmodium vivax infection is increasingly a major public health burden and the second most frequent human malaria. Higher levels of clinical severity and chloroquine resistance are major factors responsible for such increases. Malarial glomerular injury is uncommon and mainly observed in Plasmodium malariae-infected patients. Occasionally, transient immune complex-mediated glomerulonephritis is associated with Plasmodium falciparum infection. Coexistent crescentic glomerulonephritis and vivax malaria have not previously been reported. We report a fatal case of P. vivax malaria, who presented with acute renal failure. P. vivax monoinfection status was diagnosed with peripheral blood smear and rapid antigen test. Further evaluation for renal failure related to systemic illness and immunological markers were inconclusive. He was treated with antimalarial drugs, hemodialysis, and supportive therapy. Renal biopsy performed for nonrecovering renal failure reveled crescentic glomerulonephritis. This case highlights the need to thoroughly search for malaria-associated crescentic glomerulonephritis using renal biopsy after nonrecovering renal failure.     

3D flow‐independent peripheral vessel wall imaging using T2‐prepared phase‐sensitive inversion‐recovery steady‐state free precession

Purpose:

To develop a 3D flow‐independent peripheral vessel wall imaging method using T₂‐prepared phase‐sensitive inversion‐recovery (T₂PSIR) steady‐state free precession (SSFP).

Materials and Methods:

A 3D T₂‐prepared and nonselective inversion‐recovery SSFP sequence was designed to achieve flow‐independent blood suppression for vessel wall imaging based on T₁ and T₂ properties of the vessel wall and blood. To maximize image contrast and reduce its dependence on the inversion time (TI), phase‐sensitive reconstruction was used to restore the true signal difference between vessel wall and blood. The feasibility of this technique for peripheral artery wall imaging was tested in 13 healthy subjects. Image signal‐to‐noise ratio (SNR), wall/lumen contrast‐to‐noise ratio (CNR), and scan efficiency were compared between this technique and conventional 2D double inversion recovery – turbo spin echo (DIR‐TSE) in eight subjects.

Results:

3D T₂PSIR SSFP provided more efficient data acquisition (32 slices and 64 mm in 4 minutes, 7.5 seconds per slice) than 2D DIR‐TSE (2–3 minutes per slice). SNR of the vessel wall and CNR between vessel wall and lumen were significantly increased as compared to those of DIR‐TSE (P < 0.001). Vessel wall and lumen areas of the two techniques are strongly correlated (intraclass correlation coefficients: 0.975 and 0.937, respectively; P < 0.001 for both). The lumen area of T₂PSIR SSFP is slightly larger than that of DIR‐TSE (P = 0.008). The difference in vessel wall area between the two techniques is not statistically significant.

Conclusion:

T₂PSIR SSFP is a promising technique for peripheral vessel wall imaging. It provides excellent blood signal suppression and vessel wall/lumen contrast. It can cover a 3D volume efficiently and is flow‐ and TI‐independent. J. Magn. Reson. Imaging 2010;32:399–408. © 2010 Wiley‐Liss, Inc.     

Prostate cancer: results of external irradiation.

From 1975 to 1982, 205 patients with local prostate cancer were treated at the radiation oncology department, the University of Kansas Medical Center, Kansas City, Kansas. Patients'' median age was 73 years. All of the patients were staged according to American Urologic staging criteria. Twenty-eight patients had stage A2 cancer, 91 patients had stage B cancer, and 86 patients had stage C cancer. All patients were treated using megavoltage radiation (dosage range: 6000 cGy to 7100 cGy). The follow-up period ranged from a minimum of 8 years to a maximum of 15 years (median: 9.4 years). The clinical local control was 96% for stage A2, 94% for stage B, and 90% for stage C disease. The overall and disease-free survival rates were 71% and 60%, respectively. Fourteen patients developed moderate complications with one patient (0.5%) requiring surgical intervention. The local control and survival rates reported in this study are comparable with surgical results, suggesting that external beam irradiation in prostate cancer is safe and effective.     

Impact of left ventricular dyssynchrony by phase analysis on cardiovascular outcomes in patients with end-stage renal disease

Background  

Cardiovascular disease is the leading cause of mortality in patients with end-stage renal disease (ESRD). While left ventricular (LV) perfusion pattern and ejection fraction (EF) are important determinant of outcome, the prognostic importance of LV dyssynchrony, which can also be assessed by gated SPECT myocardial perfusion imaging (MPI), has not been well studied in this population.     

Total knee arthroplasty in extra articular deformities: A series of 36 knees

Background:

The presence of extra articular deformities either in the femur or the tibia with arthritis of the knee makes total knee arthroplasty (TKA) technically demanding. The purpose of this study is to report outcomes with Total Knee Arthroplasty in patients with arthritis of the knee associated with extra articular deformity by intraarticular resection and soft tissue balancing.

Materials and Methods:

Thirty six knees (32 patients) who had arthritis of the knee associated with extra articular deformity, underwent total knee arthroplasty between 1999 and 2006 were included in this retrospective analysis. All patients had intraarticular resection with soft tissue balancing to correct the deformity. Full length weight bearing anteroposterior X-rays, Knee society scores, and Knee range of motion was recorded pre- and postoperatively.

Results:

The mean period of followup was 85 months (range 42-120 months). The deformities amenable to correction by intraarticular resection in our series were Femur- Coronal plane 11°-18° (mean 16.2°) Saggital plane 0°-15° (mean 10.1°) Tibia - Coronal plane 12°-24° (mean 21°). There was an improvement in the range of motion from mean of 54° preoperatively to 114° postoperatively (P value < 0.05). The Knee Society- Knee Score improved from 37 points to 85 points postoperatively (P value < 0.05). The functional score improved from a mean value of 19 to a mean of 69.5 at followup (P < 0.01). The preoperative hip knee ankle angle in the coronal plane improved from a mean of 14° ± 2° varus (26° varus to 4° valgus) to a mean of 2° ± 0.6° varus (6° varus to 2° valgus).

Conclusion:

With a good preoperative planning and templating, intraarticular bone resection and good soft tissue balancing both in flexion and extension, correction would be possible in majority of extraarticular deformities.     

Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single-stage surgery (53 cases)

Study design

Retrospective analysis of 53 patients who underwent single stage simultaneous surgery for tandem spinal stenosis (TSS) at single centre.

Objective

To discuss the presentation of combined cervical and lumbar (tandem) stenosis and to evaluate the safety and efficacy of single-stage simultaneous surgery.

Summary of background data

Combined stenosis is an infrequent presentation with mixed presentation of upper motor neuron and lower motor neuron signs. Scarce literature on its presentation and management is available. There is a controversy in the surgical strategy of these patients. Staged surgeries are frequently recommended and only few single-stage surgeries reported.

Methods

All the patients were clinico-radiologically diagnosed TSS. Surgeries were performed in single stage by two teams. Results were evaluated with Nurick grade, modified Japanese Orthopedic Association score (mJOA), oswestry disability index (ODI), patient satisfaction index, mJOA recovery rate, blood loss and complication.

Results

The mJOA cervical and ODI score improved from a mean 8.86 and 68.15 preoperatively to 13.00 and 30.11, respectively, at 12 months and to 14.52 and 24.03 at final follow-up. The average mJOA recovery rate was 48.23 ± 26.90 %. Patient satisfaction index was 2.13 ± 0.91 at final follow-up. Estimated blood loss of ≤400 ml and operating room time of <150 min showed improvement of scores and lessened the complications. In the age group below 60 years, the improvement was statistically significant in ODI (p = 0.02) and Nurick’s grade (p = 0.03) with average improvement in mJOA score.

Conclusion

Short-lasting surgery, single anaesthesia, reduced morbidity and hospital stay as well as costs, an early return to function, high patient satisfaction rate with encouraging results justify single-stage surgery in TSS. Age, blood loss and duration of surgery decide the complication rate and outcome of surgery. Staged surgery is recommended in patients above the age of 60 years.     

Conferences on a more democratic United Nations (CAMDUN) for world peace and justice

Background: The population in the Gaza Strip has been living under chronically stressful conditions as a result of the ongoing Israeli–Palestinian conflict.

Objectives: To identify health complaints reported by attendants consulting primary care physicians in the Gaza Strip.

Methods: The study took place in 10 governmental primary health care centres and 5 clinics of the United Nations Relief and Works Agency in the Gaza Strip, during autumn 2005. Self-reported health complaints were recorded through face-to-face interviews with 956 respondents using a validated and reliable questionnaire.

Results: Abdominal pain and headache were the most frequent complaints reported among patients aged 18 to 44 years, accounting for 23.3% and 22.7% of total complaints in males and females, respectively. Fatigue and joint pain were the most common complaints among patients aged 45 years and above, accounting for 26% and 33.9% of total complaints in males and females, respectively.

Conclusions: The most common complaints, as reported by patients attending PHC facilities were stress-related and could be attributed to the ongoing conflict and high level of violence and uncertainty in the area. These complaints present a challenge to primary care providers in their efforts to improve the everyday quality of life of Palestinian residents with scarce means and resources.