Physical complaints and symptoms of somatizing patients.

The purpose of the study was to describe the physical complaints and symptoms of persistent somatization patients. Individuals in the general population (age 17-49 yr) with at least 10 general admissions during an 8-yr period were studied. Persistent somatizers (i.e. patients with more than six medically unexplained general admissions) were compared with patients whose admissions could be ascribed to well-defined somatic disorders. Somatizers were characterized by multiple symptoms from many organ systems, and their physical complaints simulated most types of somatic disorder. Although some symptoms were more common than others, none were infrequent, so neither 'classic' conversion symptoms nor pain symptoms were found to be especially characteristic of the persistent somatizer. Gender had no influence on number of registered symptoms, whereas the number increases with age. The finding question the use of a predefined symptom checklist in the diagnostic criteria for somatizing disorder. The major part of the somatizers present a different illness picture when admitted with medically unexplained disorders compared with admission for which no adequate medical explanation could be found. However, one fifth had, when admitted with a medically explained diagnosis, also been admitted with the diagnosis medically unexplained at another admission. One fifth of the persistent somatizers had been admitted at least once for factitious illness, but apart from the fact that they had more symptoms and admissions, they did not differ from the other persistent somatizers.     

CROHN'S DISEASE: A COLON AND RECTAL DEPARTMENT EXPERIENCE

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (range 11–93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric tistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%. intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4). 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion. the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.     

Digit ratio and hand-grip strength in German and Mizos men: cross-cultural evidence for an organizing effect of prenatal testosterone on strength.

The ratio of the length of the second and fourth digits (2D:4D), a putative proxy of prenatal testosterone (PT), is correlated with measures of physical fitness. The relationship between the organizing effect of PT on physical fitness is likely to arise as a response to intrasexual male competition for females. Physical strength is also likely to be important in intrasexual conflict, but nothing is known concerning the relationship between 2D:4D and strength. The strength of an individual is strongly influenced by body size, and 2D:4D is strongly dependent on ethnicity. We present evidence that strength, as measured from hand-grip strength, is related to 2D:4D in samples from two ethnic groups (52 Caucasian men from Germany, and 88 Oriental Mizos men from northeast India) which differed markedly in size. We found that 1) the German men were heavier and stronger, but had higher 2D:4D (lower PT) than the Mizos men; 2) a median split for grip strength into low (LGS) and high (HGS) groups showed that for right-hand 2D:4D (but not left-hand 2D:4D), the LGS men had higher 2D:4D than the HGS men; and 3) the relationships between right 2D:4D and grip strength were independent of ethnicity, age, height, and weight. Measures of grip strength correlate strongly with strength in other muscle groups, so we conclude that PT may have an early organizing effect on strength in men, and this is likely to be widespread in human groups.     

Dealing with psychiatry's stigma

The stigma associated with psychiatry is the most critical problem facing the profession, the author contends. He identifies the major sources of stigma as psychiatrists' internal conflicts over treatment ideologies and methods and the hostility between psychiatrists and other physicians that has led to disparagement of psychiatry as a medical specialty. To combat the stigma he recommends that highest priority be given to efforts to unify the profession and to increase psychiatry's participation in organized medicine. He also urges psychiatrists to limit self-revelation and self-exploration in the media, to emphasize the broad range of knowledge and skills that makes them uniquely suited to perform evaluative and triage functions, and to halt the current practices of shunting whole classes of patients off to other disciplines for care and of educating other disciplines in psychiatric techniques.     

Rotatory palmar subluxation of the lunate in post-traumatic ulnar carpal translocation

Post-traumatic ulnar carpal translocation is a rare, severe ligamentous injury to the wrist. Radiologic findings include widening of the radiocarpal joint space at the radial styloid process and ulnar displacement of the carpus. Less than 50% of the lunate articulates with the radius in the neutral position; the lunate is tilted dorsally with palmar subluxation due to a ruptured radioscapholunate (RSL) ligament. This malposition should be called rotatory palmar subluxation of the lunate (RPSL), by analogy to rotatory subluxation of the scaphoid (RSS). In contrast to dorsiflexed intercalated segment instability (DISI), in RPSL the RSL ligament is ruptured and, in the majority of cases, the scapholunate ligament remains intact. A prompt diagnosis should lead to successful treatment.     

Influence of rigid contact lens base curve radius on tear pump efficiency.

The effects of rigid contact lens base curve radius changes on tear pump efficiency were determined by measuring oxygen uptake on six with-the-rule corneas (with toricities between 0.37 and 1.00 D) under three conditions: (1) normal open eye, (2) after 5 min of static (without blinking) wear of polymethyl methacrylate (non-gas permeable) contact lenses, and (3) after 5 min of dynamic (with blinking once every 5 s) wear of the same lenses. The difference between the oxygen uptake rates measured under static and dynamic conditions provides an index of tear pump efficiency. Each subject wore a series of five lenses: fitted on K and 0.05 or 0.10 mm steeper and flatter than the flattest corneal meridian. The overall diameter of all lenses was 8.8 mm, the optic zone was 7.4 mm, the axial edge lift was 0.09 mm, and all other parameters were constant. The contact lens fitted on K was associated with the greatest central corneal oxygen debt under static conditions, whereas the same lens also provided for the best tear exchange with the blink. In addition, better tear exchange was found to be associated with larger palpebral aperture sizes.     

BRCA2与LIM结构域蛋白FHL2的相互作用

目的：应用酵母双杂交方法筛选BRCA2相互作用蛋白编码基因，验证其相互作用并研究其功能联系。方法：以BRCA2基因3′端片段构建酵母双杂交质粒，筛选正常人乳腺上皮细胞cDNA库，获得编码相互作用蛋白的基因，采用免疫共沉淀、哺乳细胞双杂交和荧光酶测定等方法进一步验证蛋白间相互作用和功能联系．结果：采用酵母双杂交系统筛选，获得了多个编码BRCA2相互作用蛋白的基因，其中包括已知的FHL2蛋白；免疫共沉淀和哺乳动物细胞双杂交试验显示BRCA2和FHL2在体内特异性结合，并证实FHL2在体内形成同源二聚体；转录活性分析发现BRCA2与FHL2有协同转录激活作用。结论：发现BRCA2与FHL2蛋白间相互作用和功能联系，为BRCA2功能研究提供了新的方向。