Orthodox Judaism and psychoanalysis: toward dialogue and reconciliation

The authors examine the conflicted relationship between Orthodox Judaism and psychoanalysis. Orthodox Jewish thinkers about psychology have responded to psychoanalysis as incompatible with the practice of Orthodox Judaism. On the other hand, those psychoanalytic writers who have examined the beliefs and practices of Orthodox Jews have tended to treat these issues in a reductionistic fashion. However, the authors find possibilities for reconciliation and dialogue in the work of Aaron Rabinowitz and Moshe Halevi Spero.     

Borderline ovarian tumors in reproductive-age women. Fertility-sparing surgery and outcome

OBJECTIVE: To evaluate the fertility and survival outcomes in young women with borderline ovarian tumors treated with fertility-sparing surgery. STUDY DESIGN: From 1985 to 2002, 25 women with borderline ovarian cancers surgically managed with preservation of the uterus and at least a portion of 1 ovary were identified from tumor registry databases at 2 southern California hospitals. Data for analysis were collected from hospital charts, office records and tumor registry files. RESULTS: Twenty-five patients (median age, 29 years) with borderline ovarian tumors, including 10 with stage IA, 3 with stage IC, 1 with stage IIIA and 11 with unstaged disease, underwent fertility-sparing surgery, consisting of unilateral adnexectomy in 19, unilateral adnexectomy with contralateral cystectomy in 5 and unilateral cystectomy in 1. No disease recurred, providing an overall survival of 100%. Fertility status was available on 15 patients 4-157 months after surgery; 6 of them attempted to become pregnant. Five women had successful pregnancies, with a total of 5 live births. One woman underwent assisted reproductive techniques, became pregnant but aborted. The median follow-up was 80 months (range, 4-157). CONCLUSION: Conservative surgery for borderline ovarian tumors should be considered for women in the reproductive age group who desire preservation of fertility.     

Treatment of intestinal worms is associated with decreased HIV plasma viral load

BACKGROUND: We have previously suggested that helminthic infections make the host more susceptible to HIV infection and enhance its progression due to the chronic immune activation they cause. OBJECTIVE: To study the effect of antihelminthic treatment on HIV plasma viral load (VL) in HIV- and helminth-infected individuals living in Ethiopia. METHODS: Fifty-six clinically asymptomatic HIV-1-infected individuals, 31 (55%) of whom were also infected with helminths, were studied. All participants received antihelminthic treatment at baseline and at 3 and 6 months. Worm egg excretion, HIV plasma VL, and T-cell subsets were determined at baseline and 6 months after treatment. RESULTS: The mean age, number of CD4 T cells, and gender distribution were similar in the helminth-infected and -noninfected groups. At baseline, HIV plasma VL was strongly correlated to the number of eggs excreted (p <.001) and was higher in individuals infected with more than one helminth (5.28 +/- 0.35 versus 4.30 +/- 1.13 log RNA copies/mL, respectively; p =.16). After treatment of helminths, the 6-month change in HIV plasma VL was significantly different between the successfully treated group and the persistently helminth-positive group (p =.04) CONCLUSIONS: Helminth "load" is correlated to HIV plasma VL, and successful deworming is associated with a significant decrease in HIV plasma VL. The results of the current study, if confirmed in a larger study, may have important implications for slowing disease progression and reducing risks of transmission.     

Clinical signs of pulmonary congestion predict outcome in patients with acute chest pain

BACKGROUND: Pulmonary congestion is associated with poor outcome in patients with acute coronary syndromes. In consecutive patients presenting with acute unexplained chest pain to a primary care facility, the prognostic impact of pulmonary congestion is indeterminate. Therefore, we assessed the predictive value of clinical signs of pulmonary congestion in patients presenting with acute chest pain to an emergency department with regard to the origin of the symptoms. METHODS: 1288 consecutive patients with acute chest pain were prospectively assessed for clinical signs of pulmonary congestion. The diagnosis was confirmed by chest radiography. The association of pulmonary congestion and short- and intermediate-term mortality in patients with coronary (n = 381) and non-coronary (n = 907) causes of chest pain was determined using multivariate Cox regression analysis. RESULTS: 108 (8%) patients had clinical signs of pulmonary congestion. Within the mean follow-up period of 23 months (SD 4) 67 patients died, mainly within the first 6 months. Of 108 patients with pulmonary congestion, 82 (76%) had coronary and 26 (24%) had non-coronary chest pain. Pulmonary congestion was independently associated with mortality in patients with coronary chest pain (hazard ratio 6.4, 95% confidence interval 2.5 to 16.1, p < 0.0001), both in patients with acute coronary syndromes or angina pectoris. However, in patients with non-coronary chest pain we observed no independent association of pulmonary congestion with outcome. CONCLUSION: Clinical signs of pulmonary congestion indicate an increased risk for poor outcome in patients with chest pain due to myocardial ischemia. Mortality of these patients is high, particularly in the first months after presentation. Therefore, hospital admission is warranted, including patients with angina pectoris, who otherwise may be candidates for early discharge.     

Functional deficits in athletes with a history of low back pain: a pilot study

OBJECTIVE: To evaluate whether athletes with a history of low back pain (LBP) would, on average, perform slower on a timed 20-m shuttle run as compared with a normal athletic population. DESIGN: A timed shuttle run to evaluate residual functional limitations in college athletes with resolved LBP. SETTING: National College Athletic Association (NCAA) division I college. PARTICIPANTS: NCAA division I athletes (161 men, 50 women). INTERVENTION: A timed 20-m shuttle run. MAIN OUTCOME MEASURE: Each athlete was timed in a divided 20 m (66 ft) run in which 2 taped lines were positioned 6.7 m (22 ft) apart. RESULTS: Of 211 athletes evaluated, 27 had been treated for LBP during the previous year. Currently asymptomatic athletes with a recent history of LBP were slower (6.3s vs 5.8s) during performance of the timed 20-m shuttle run than athletes without LBP (P=.0002). CONCLUSIONS: Athletes with resolved LBP were slower than a matched group of normal athletes without LBP in the timed 20-m shuttle run. Further research is needed to support these findings and to understand fully the influence of the kinetic chain and the effects of both gender and sport on the observed findings.     

Effect of the aqueous extract of Chrysanthellum indicum on calcium mobilization and activation of rat portal vein

The effects of the aqueous extract of Chrysanthellum indicum (CI) on calcium activation and mobilization were studied using the rat portal vein. The extract caused a concentration-dependent contraction of the portal vein. KCl (80 mM), norepinephrine (NA, 10(-6)M) and CI (4 mg/ml) evoked sustained contraction of the portal vein. In Ca-free medium (with EGTA) the contractions evoked by these agents were reduced significantly. The times-to-peak of KCl, NA and CI were similar -in normal PSS, but in Ca-free medium the times-to-peak for KCl and CI were greatly increased. The contractions induced by CI were not inhibited by chlorpropamide and prazosin, but were blocked by verapamil. The data obtained suggest that the aqueous extract of CI utilizes extracellular calcium pools to bring about contractile response and this effect might be mediated through the activation of potential-sensitive channels.