Body piercing: issues in adolescent health.

Ask the Expert provides research‐based answers to practice questions submitted by JSPN readers.     

Early experience with minimally invasive esophagectomy in head and neck surgical patients

BACKGROUND: Minimally invasive esophagectomy (MIE) via thoracoscopy and laparoscopy have reduced the morbidity and mortality of total esophagectomy at experienced centers. MIE has not been evaluated in combination with major head and neck surgery, or in the otolaryngology literature. METHODS: Case series of 11 consecutive patients undergoing either open or MIE with an ablative neck procedure. RESULTS: Comparing 4 MIEs and 7 open operations, similar operative time, blood loss, and ICU and hospital length of stay were observed. There was one mortality in the open group. A 100% rate of major complications was observed in the MIE group. CONCLUSION: Our multidisciplinary team was unable to achieve improved outcomes in a series of head and neck surgical patients undergoing MIE. This result may represent an early stage of the learning curve for MIE, but may also be attributed to the escalated surgical requirements of head and neck patients.     

Modifiers of non-specific symptoms in occupational and environmental syndromes.

Many occupational and environmental health hazards present as an increased reporting of non-specific symptoms such as headache, backache, eye and respiratory irritation, tiredness, memory problems, and poor concentration. The pattern and number of such symptoms is surprisingly constant from hazard to hazard suggesting that common psychological and social factors, not directly related to the exposure may be involved. A recent workshop (see acknowledgements) was held to review the pattern of symptoms in varying hazardous situations and the psychological mechanisms behind the genesis and maintenance of symptoms. The involvement of both direct physicochemical and psychological mechanisms in symptom generation and reporting in any situation was discussed and is reported here. A model that identifies the issues that need to be considered in any epidemiological study based on the incidence or prevalence of non-specific symptoms is proposed.     

Adenocarcinomain Situof the Uterine Cervix: Management and Outcome

Objective: To retrospectively review the management of adenocarcinomain situof the uterine cervix, to determine the outcome of conization versus hysterectomy, and to compare the results achieved by different methods of conization. Methods: We performed a retrospective pathology and chart review of 46 patients with cervical adenocarcinomain situfrom January 1980 to October 1994. Results: Nine patients were managed during the first half of the study period and 37 were managed in the second half. The mean age of patients was 38.4 years (range 25–72). Forty-five of 46 patients were diagnosed as a result of an abnormal Pap smear, although only 19 smears indicated adenocarcinomain situor other glandular abnormalities. Cold knife conization resulted in a 33% rate of positive margins for adenocarcinomain situcompared to 50% for large loop excision of the transformation zone (LLETZ). Among 24 conservatively managed patients with negative conization margins, there have been 2 (8.3%) recurrences of adenocarcinomain situ.Among patients not undergoing hysterectomy as definitive treatment, 1 of 18 (6%) patients undergoing cold knife conization recurred, compared to 4 of 14 (29%) managed with LLETZ, despite a 63.4-month shorter mean follow-up interval for the LLETZ patients. Conclusions: Cold knife conization is associated with a lower rate of recurrence of cervical adenocarcinomain situcompared to LLETZ. We recommend cold knife conization for patients who are not treated with hysterectomy.     

Survival Strategies for Nurse-Midwifery Students

Nurse-midwifery students face multiple stressors in their educational experience. Strategies to resolve stress and promote adaptation to the new role are examined and measures used to promote students' adaptation to the educational experience are described.     

Disordered recognition and perception of human faces in acute schizophrenia and experimental psychosis

Three disorders of facial recognition and perception in acute schizophrenia and mescaline-induced psychosis are described and illustrated using original clinical and experimental material: "affective prosopagnosia" or stress-related dysfunctional face recognition; "physiognomization" of the environment or persistent illusions and hallucinations of nonspecific faces; and the "mirror phenomenon" or the experience of inner alienation from one's reflected face, which is perceived as independently alive, sinister, and generally physically distorted. It is proposed that neuropsychology suggests relationships between these phenomena that might otherwise be less apparent. No final neurobiological solution to the problem of dysfunctional facial perception and recognition in psychosis is presented, but various insights and suggestive models from the neurosciences are discussed. Attention is also paid to the conditions under which one might need to combine neuropsychological approaches with hermeneutically oriented analyses.     

Psychiatry and the history of the localization of psychological functions

The problem of the localisation of mental functions in the brain is historically analysed with special attention to its implications for psychiatry. The aim is not to discuss the historical details of the relationship between psychiatric models of madness and neurological models of brain functioning, but to cast some light on the broad intellectual and social framework within which the relationship became possible in the first place. It is argued that debates about the localizability of psychological processes are always more than just debates about structure-function correlation, and must in fact be ultimately understood as part of the much larger historical attempt within the natural sciences to "naturalize" man and his mind. Emphasis is laid on the extent to which different positions within the localisation debate have been influenced by unspoken social (political, religious) and philosophical factors, and questions are raised about the implications of this fact for modern neuropsychology and neuropsychiatry.     

Mononuclear-cell subsets in human idiopathic crescentic glomerulonephritis (ICGN): Analysis in tissue sections with monoclonal antibodies

Mononuclear inflammatory cells (MIC) were analyzed in renal biopsies from 16 patients with ICGN (7 with glomerular immune complex deposits, 3 with anti-GBM disease, and 6 without immune deposits) by the avidin-biotin-immunoperoxidase technique utilizing monoclonal antibodies to cell surface antigens: T11 (total T), T4 (inducer/helper T), T8 (suppressor/cytotoxic T), B1 (B cells), M1 (monocytes/granulocytes), and Leu 7 [natural killer (NK) cells]. Total MIC were significantly increased in both glomeruli and interstitial tissues of the patients. Interstitial MIC consisted mainly of lymphocytes (80%) and monocytes (19%), with small numbers of B and NK cells present. In contrast, MIC in renal glomeruli of patients with ICGN were composed of monocytes (65%) rather than T lymphocytes (34%). A majority of T lymphocytes found in renal tissues of patients and controls had the helper/inducer phenotype. Tissue T4/T8 ratios were not significantly different in the glomeruli and interstitium. Monocytes and T lymphocytes accumulating in renal tissues of patients with ICGN may mediate glomerular injury in all forms of human ICGN.Presented in part at the 15th Annual Meeting of the American Society of Nephrology, Chicago, Illinois, 1982.     

Identification of Potential Diagnostic and Vaccine Candidates of Helicobacter pylori by Two-Dimensional Gel Electrophoresis, Sequence Analysis, and Serum Profiling

There is great interest in characterizing the proteins of the gastric pathogen Helicobacter pylori, especially those to which humans respond immunologically, because of the potential importance of such proteins in diagnosis and vaccine development. Two-dimensional gel electrophoresis was used to separate and identify potential antigens of H. pylori ATCC 43504. Over 30 proteins were reactive in Western blots with pooled sera from 14 infected patients. These proteins were analyzed by N-terminal sequence analysis. Fourteen proteins were determined to be distinct from any proteins previously described from H. pylori; the others were previously isolated and characterized proteins. Analysis of eight distinct H. pylori strains showed that most of these antigens were produced by all of the strains. We propose that collection of new antigens such as those recognized here will be useful in serologic tests for detecting and monitoring H. pylori infection and may also serve as potential targets for antimicrobial agent or vaccine development.