Concept of computed tomography (CT) of the temporo-mastoid bone : Normal CT anatomy and their variations

Computed tomography is being increasingly employed in the radiographic assessment of the temporal bone. Recent introduction of high-resolution computed tomography (CT) which is capable of resolving the delicate bony structures of the temporal bone and adjoining region of the base of the skull has made radiological visualisation much more easier. Thin section 2 (1) mm at an interval of 2 (1) mm in different planes like 0°, 30°, 70° clearly demonstrated the cochlear turns, oval and round windows, internal auditory canal, ossicles, vestibule, semi-circular canals, facial nerve canal and adjacent regions of the skull base. Thus the high-resolution CT virtually replaced the conventional radiography and polytomography in evaluation and treatment planning of patients with temporomastoid bone pathology.     

Increased serotonin2 and beta-adrenergic receptor binding in the frontal cortices of suicide victims

A statistically significant 28% increase in the mean (+/- SD) number of serotonin2 receptors (127.8 +/- 13.4 vs 99.6 +/- 11.1 fmol/mg of protein) and a 73% increase in beta-adrenergic receptor binding (14.5 +/- 1.5 vs 8.4 +/- 1.5 fmol/mg) was found in the frontal cortices of violent suicide victims compared with matched controls. No significant differences were found in the number of serotonin1 binding sites (109.5 +/- 13.4 vs 99.9 +/- 8.8 fmol/mg). We have previously reported a reduced density of presynaptic tritiated imipramine binding sites on serotonergic nerve terminals in the frontal cortices of suicide victims. These data support the hypothesis that suicide completed by violent methods is associated with reduced presynaptic serotonergic activity that has generated compensatory upregulation of the postsynaptic serotonin2 receptor sites. The increase observed in beta-adrenergic binding suggests that there may also be a concomitant reduction in presynaptic noradrenergic activity associated with suicide. If antidepressant pharmacotherapies specifically downregulate cortical beta-adrenergic and/or serotonin2 receptors in depressed subjects, as has been demonstrated in animal studies, and since these effects would be in the opposite direction of the receptor changes found in suicide victims, they may account for the therapeutic action of antidepressants on suicidal behavior and depressive disorders.     

TRANSFORMATIONAL, CONSERVATIVE AND TERMINAL OBJECTS: THE APPLICATION OF BOLLAS'S CONCEPTS TO PRACTICE

ABSTRACT This paper focuses on Christopher Bollas's contributions to the understanding of transformations in object usage. Bollas has delineated numerous kinds of object usage but has not described the possible transformations that could occur as a result of psychotherapy. The author examines conservative and terminal objects, on the one hand, and transformational objects, on the other hand, as signifiers for the kinds of transformation that are likely to occur in psychotherapy. Two vignettes informed by Bollas's ideas will illustrate how the therapist can facilitate the patient' s use of the therapeutic environment that'transforms' rather than'conserves' or'terminates' psychic evolution. The author describes how Bollas draws from diverse theoretical sources, particularly from Freud, Winnicott and Bion. The author also suggests that unrestricted use of different theoretical frameworks is consistent with Bollas's favoring free movement between different modes of interpretation. It is argued that this flexibility of moving between modalities is indeed the chief distinguishing characteristic of Bollas's therapeutic style.     

Use of the TLX ultracentrifuge for the isolation of different density lipoproteins and effects of freeze/thawing of human plasma before ultracentrifugation

Abstract Background: Isolation of different density lipoproteins by ultracentrifugation can require lengthy centrifugation times and freeze/thawing of plasma may influence recovery. Methods: We isolated a range of lipoproteins using a preparative ultracentrifuge and the TLX micro-ultracentrifuge and determined the effect of freeze/thawing of plasma beforehand. Results: In fresh plasma, there was no significant difference in results for small-dense low-density lipoprotein apolipoprotein B (LDL apoB) (density >1.044 g/mL) or cholesterol at density >1.006 g/mL. Freeze/thawing had no effect on closely correlated results for small-dense LDL apoB (r=0.85; p<0.0001) or high-density lipoprotein (r=0.93; p<0.0001). Conclusions: The TLX micro-ultracentrifuge is a reliable alternative to the preparative ultracentrifuge and freeze/thawing has only a small effect on small-dense LDL apoB or high-density lipoprotein cholesterol. Clin Chem Lab Med 2008;46:1285-8.     

Individualised treatment in alcohol-dependent patients

Long-term relapse prevention is the biggest challenge in treating alcohol-dependent patients. It is equally based on psychotherapy and pharmacotherapy. Psychotherapy includes motivational interviewing, community reinforcement, cognitive behavioural therapy, motivational enhancement, twelve-step facilitation, social network behaviour therapy, cue exposure, etc. For pharmacological treatment, we dispose of disulfiram, acamprosate and naltrexone. Reviews and meta-analyses reveal only modest effect sizes of these approaches probably because they are usually tested in large and heterogeneous samples where “one size does not fit all”. However, attempts to form more homogeneous subgroups for which specific psychotherapies should be more effective (“matching”) also failed. We suppose that this failure may have to do with the fact that these studies used only psychopathology and behavioural analyses as a basis for subtyping. Things look more promising once biologically defined endophenotypes are used as well in order to form more homogeneous subgroups. For example, naltrexone treatment seems more effective in carriers of a specific variant of the mu-opioid receptor gene. The same could be true for acamprosate if a newly found polymorphism was used to preselect potential responders. Very recently biological differences between patient groups are also being detected using functional imaging. Naltrexone is suggested to work better in a subgroup of patients with higher cue reactivity when shown appetitive alcohol pictures. MR spectroscopy of brain glutamate levels may detect potential acamprosate responders. On such a basis, an individualised approach in the treatment of alcoholism (“personalised medicine”) seems to hold promise.

     

A soluble factor produced by macrophages mediates the neurotoxic effects of HIV-1 Tat in vitro.

OBJECTIVES: There is now a strong consensus that the neurotoxic properties of HIV-1 are likely to be mediated by an indirect mechanism in which neurones are damaged by infected mononuclear cells. The aim of this study was to determine the ability of HIV-1 Tat to induce neurotoxic properties in a murine macrophage cell line RAW264.7. DESIGN: Simple culture systems using dissociated neurones may not provide the appropriate microenvironment in which to observe the complex cell-cell interactions that occur in the brain. We have therefore developed a more physiological model in which rat organotypic hippocampal slices are co-cultured with the murine macrophage cell line RAW264.7. Effects of Tat were studied by using a stable Tat expressing RAW264.7 cell line or by addition of recombinant Tat protein to co-cultures. METHODS: Organotypic hippocampal slices prepared from 8-10 day rat pups were grown on membrane inserts that were placed into six-well plates on which RAW264.7 cells were growing as an adherent monolayer. Cell death in the slices was assessed using propidium iodide. Specific astrocytic (glial fibrillary acidophilic protein; GFAP) and neuronal (microtubule-associated protein; MAP2) markers were visualized by immunocytochemistry. RESULTS: RAW264.7 cells that either expressed or were exposed to HIV-1 Tat protein, produced a soluble factor that caused profound degeneration in brain slice cultures involving loss of both glial cells and neurones. By contrast treatment of slice cultures with Tat in the absence of RAW264.7 cells was not neurotoxic. CONCLUSIONS: The neurotoxic properties previously attributed to HIV-1 Tat are likely to be mediated via induction of macrophage derived soluble factor(s).     

Predicting Utilization of Dental Services by the Aged

This article reports the results of a study of factors that differentiate among utilizers and nonutilizers of dental services in old age. Two hundred community-dwelling subjects aged 60-89 were surveyed regarding utilization of dental services, dentate status, current treatment needs, recent symptom experiences, and dental fear and anxiety. Discriminant analysis was used to differentiate among utilizers and nonutilizers. Dentate status, perceived need, and recent symptom experiences were the best predictors of utilization. The contribution to accurate classification made by two measures of dental fear and anxiety was marginal at best. When dentate status was removed as a predictor, the role of fear and anxiety became somewhat more important.     

Psychiatric disturbance and decision-making

The relationship between psychiatric disorder (as measured by severity of psychoneurotic status and depression) and decision-making behaviour was examined in a sample of 39 hospitalised patients. Measures based on the conflict theory of decision-making of Janis and Mann (1977) and the expectancy-value theory of decision-making of Edwards (1961) were administered. Patients who scored highest on measures of psychoneurotic disorder--the Middlesex Hospital Questionnaire and the Beck Depression Inventory--were least confident about their decision-making. They also reported a high use of maladaptive decision-making coping patterns, in particular decision avoidance. Slightly over one-half of the patients demonstrated an ability to make rational decisions, while the remainder made either irrational decisions or avoided making any decision at all. Observation in the test session revealed that patients were strikingly slow in answering the questionnaires and often attempted to make no response. The importance of this area of research for patient assessment and treatment is discussed.