Somatisation in Children

This review summarises recent work on somatisation in childhood. Minor physiological dysfunction may play a part in a number of cases and associated psychiatric disorders are commonly though not universally found. Contributory family factors include high rates of health problems and of parental psychological distress and there is some evidence for the role of family modelling and reinforcement of illness behaviour. There is suggestive evidence linking somatisation to emotional closeness in families, to family togetherness around health matters and to anomalies in children's social relationships. Somatisation in children can respond to treatments involving cognitive–behavioural and family techniques as well as to sensitive, psychologically sound advice from paediatricians.     

Maternal expressed emotion and adjustment in children with epilepsy

Epilepsy in childhood may alter family relationships but the relevance of these changes for the increased rates of psychopathology has been little investigated. This study uses maternal expressed emotion (EE) to examine family relationships of children with epilepsy and the association with high risk for psychiatric disorder. EE was assessed using the Camberwell Family Interview carried out with the mothers of 22 schoolchildren with chronic epilepsy who were attending a general hospital outpatient clinic. Sixteen of these children had similarly aged healthy siblings who served as controls. High risk for psychiatric disorder in the children and mothers was assessed using behavioural, mood, and self-esteem questionnaires completed by mothers, teachers, and children. It was found that mothers showed significantly more emotional overinvolvement and a trend for more hostility towards their children with epilepsy than towards sibling controls. For the 22 children with epilepsy, maternal emotional overinvolvement was not associated with child behavioural deviance. High levels of criticism and, to a lesser extent, hostility did show associations with child behavioural deviance, and the strongest links were between maternal criticism and maternal rated antisocial and overactive behaviour in the child. Fewer positive comments by mothers towards the children were associated with child emotional symptoms and lower self-esteem in a number of areas. This study suggests that further research could consider the appropriateness of psychological intervention for families in which mothers are critical and hostile and whose children show antisocial behaviour.     

Straight line sign: appearance and significance during CT portography

The computed tomographic (CT) angiograms of 44 patients who were being evaluated for possible hepatic surgery were studied. All patients were imaged with CT arterial portography (CTAP), delayed CT of the liver, and magnetic resonance (MR) imaging. All CTAP studies were evaluated for a "straight line," a linear variation in contrast within the liver. Sixteen patients (36%) demonstrated the straight line sign. All 16 had a mass at the proximal portion of the defect. Nine of 16 had defects that clearly correlated with portal venous distribution seen at limited digital angiography. Fourteen of the 16 patients showed loss of the straight line sign at delayed CT and/or MR imaging of the liver. These defects are thought to be due to vascular obstruction. The straight line sign will probably be seen more frequently as CTAP is more commonly used. Recognition of the sign is important in the evaluation of primary liver carcinomas, since it signifies that the tumor may be inoperable. Also, if metastatic disease is present, it alerts the surgeon to the proximity of the portal vein to the neoplasm.     

Complex fractures of the proximal humerus: role of CT in treatment

The authors reviewed the computed tomography (CT) scans, plain radiographs, and subsequent treatment of 17 patients with complex proximal humeral fractures. CT scans and radiographs were compared in the demonstration of fracture lines, displacement of fracture fragments, rotation of fragments relative to their normal positions, and status of the head and articular surface of the humerus. The impact of CT findings on the decision to treat with surgery versus closed reduction and on the choice of surgical procedure was assessed. Surgery was not performed in nine patients because CT scans showed no significant displacement of fragments previously judged displaced or "indeterminate" on radiographs. Surgery was performed in eight patients; CT demonstrated significant abnormalities not definitely shown with radiography. In six of these eight patients, CT scans demonstrated unsuspected abnormalities that directed the choice of surgical procedure. CT scans provide clinically useful information for the treatment of complex proximal humeral fractures when radiographs provide inadequate or indefinite information.     

Severe chronic fatigue syndrome in chidhood: A discussion of psychopathological mechanisms

Severe chronic fatigue syndromes are rare in childhood. Two severely affected children are described, one presenting in an extreme withdrawal state. Possible psychopathological mechanism are discussed including the relevance of viral illnesses, depressive symptoms, characteristic child personality and family relationship. These mechanisms are comparable to those described for other functional somatic problems of childhood, suggesting their general relevance in the maintenance of the somatization of distress in childhood. Treatment strategies are described which resulted in recovery in both cases.

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Zusammenfassung Schwere Chronic Fatigue Syndrome sind im Kindesalter selten. Wir beschreiben zwei schwer betroffene Kinder, wobei eines ein ausgeprägtes Rückzugsverhalten zeigte. Mögliche psychopathologische Mechanismen werden diskutiert, u. a. Viruserkrankungen, depressive Symptome, charakteristische kindliche Persönlichkeit und familiäre Beziehungen,. Diese Mechanismen sind mit anderen funktionellen somatischen Störungen im Kindesalter vergleichbar und deuten auf deren allgemeine Relevanz für die Aufrechterhalung von Somatisierungen in Folge von seelischer Belastung hin. Die therapeutischen Vorgehensweisen werden beschrieben, die in beiden Fällen zur Heilung führten.

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Résumé Les syndromes de fatique sévère sont rares dans l'enfance. Deux enfants sévèrement atteints sont décrits, un présentant und dgeré de retrait extreme. Les mécanismes psychopathologiques possibles sont discutés y compris l'opportunité de maladies virales de symptômes dépressifs ainsi que les caractéristiqué de la personnalité de l'enfant et des relations familiales. Ces mécanismes sont comparables à ceux décrits pour d'autres problèmes somatiques fonctionnels de l'enfance suggérant leur adéquation générale dans le maintien de la somatisation de la détresse dans l'enfance. Les stratégies thérapeutiques sont décrities, qui ont abouti à la guérison dans les deux cas.

     

DNA methylation and mental retardation

Interaction between chromatin proteins MECP2 and ATRX is disrupted by mutations that cause inherited mental retardation
Nan et al. (2007)
Proc Natl Acad Sci U S A 104: 2709–2714
Structural consequences of disease-causing mutations in the ATRX-DNMT3-DNMTL (ADD) domain of the chromatin-associated protein ATRX
Argentaro et al. (2007)
Proc Natl Acad Sci U S A 104: 11939–11944     

Saturation multipoint linkage mapping of chromosome 6q in type 1 diabetes

Linkage analysis of type 1 diabetes sib pair families (n = 334) has suggested two separate regions of human chromosome 6q are linked to disease (designated IDDM5 and IDDM8). To test if these are false positive results, all available sib pair families (n = 429) were typed using a 92% informative map of chromosome 6q and multipoint analysis. The two regions still showed positive evidence of linkage, most notably the proterminal region, 6q27, corresponding to IDDM8 (MLS = 2.57, p = 0.0006; lambda s = 1.17). In addition, some evidence of transmission disequilibrium was seen with marker a046xa9 (IDDM5).      

Effects of follicular fluid supplementation of in-vitro maturation medium on the fertilization and development of equine oocytes after in- vitro fertilization or intracytoplasmic sperm injection

The aim of this study was to compare the effect of the addition of follicular fluid (FF) collected from preovulatory follicles with that of oestrous mare serum (EMS) (acting as the control) to TCM-199 medium on the in-vitro maturation, fertilization and development of equine cumulus-enclosed oocytes. Oocytes (<30 mm in diameter) were obtained from the ovaries of slaughtered mares. After in-vitro maturation in the presence of the two supplements, their fertilization, cleavage and developmental potential were compared after conventional in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) using frozen-thawed spermatozoa. Follicular fluid did not increase the maturation of oocytes to metaphase II stage compared to control. After IVF, there was no difference in fertilization rates between FF- supplemented oocytes and controls (7/87, 8.4% of oocytes showing two pronuclei with FF versus 7/116, 6% with EMS; not significant). However, after ICSI, FF-supplemented oocytes showed significantly increased normal fertilization (32/85, 37.6% of two-pronuclear oocytes) and developmental potential (15/31, 48% cleavage) compared to the control oocytes (7/47, 14.9%, P < 0.01; and 2/48, 4%, P < 0.01, respectively). Overall, ICSI resulted in increased fertilization rates compared to IVF, regardless of the presence or absence of FF (39/132, 29.5% with ICSI versus 14/203, 6.9%). These results suggest that follicular fluid supplementation may improve the maturity of equine cumulus-enclosed oocytes sufficiently for the successful use of ICSI, but not sufficiently for normal sperm-egg interaction occurring during IVF.      

Psychophysiological anomalies in children with emotional and conduct disorders.

We studied patterns of psychophysiological (skin conductance, heart rate) reactivity to sounds and to situations with varying emotional and alerting connotations in child psychiatric outpatients and in healthy controls. Children with emotional disorders were particularly reactive to situations with aversive components, while conduct disorder subjects showed increased reactivity to pleasant situations and decreased responses to neutral but high-intensity stimulation and to withdrawal of stimulation in silence periods. The results indicate patterns of biological reactivity which may underlie different psychiatric disturbances in children.     

Identification of primary lysosomes in human megakaryocytes and platelets

The presence of lysosomal enzymes in human platelets is well documented; the identity of the "lysosome," however, has been the subject of some disagreement. In order to determine the time of appearance and subcellular localization of two lysosomal enzymes in megakaryocytes (MK) and platelets, we examined normal human bone marrow and blood by electron microscopy and cytochemistry. Acid phosphatase (AcPase) was present in the Golgi region in the youngest recognizable MK, as well as in those with a considerable degree of cytoplasmic maturation. Heavy reaction product was usually confined to one or two Golgi-associated cisternae and coated vesicles; other Golgi cisternae were sometimes lightly reactive. In mature MK, reaction product was limited to vesicles of variable size, but smaller than alpha-granules. Another lysosomal enzyme, arylsulfatase (AS), was localized in similar small vesicles in MK of all stages; it could not be demonstrated in the Golgi complex. Vesicles containing AS were also found in about 25% of platelet profiles, whereas vesicles containing AcPase were found in only about 15% of platelet profiles. The alpha-granules of all MK and platelets examined were negative for both enzymes. We conclude that the enzyme-containing vesicles in these cells constitute the lysosomes and that they are distinct from other platelet organelles. Since there was no evidence that they had participated in any digestive event, we believe that they are primary lysosomes, whose contents are secreted during platelet aggregation and the release reaction.