Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy

In order to elicit the usefulness of sural nerve biopsy we retrospectively evaluated the courses of disease of every patient, who underwent this procedure in our department between January 1995 and March 2000. Sixty seven patients with the suspected diagnosis of peripheral neuropathy could be included. From these chart reviews and patient questionings were done. Inflammatory-demyelinating neuropathies were suspected in 14 patients (20.9%), specific histological findings confirmed diagnosis in 50% of these patients and resulted in therapy. In cases of polyneuropathy of unknown etiology (46 patients, 68.6%) diagnosis was made in 11 patients (23.9%), and lead to therapy in 9 patients (19.6%), merely. In all, diagnostic consequences arouse in 32.8%, therapeutic consequences in 26.9%. The follow-up of 47 patients (mean 24.4 months) found chronic pain in the distribution of the sural nerve in 14 patients (29.8%), dysesthesia in 22 patients (46.8%), and persistent sensory loss in 34 patients (72.3%). Only 24 patients (51.1%) would submit to biopsy again. Because of high complication rates and poor results we conclude that sural nerve biopsy should be done only in carefully selected cases after thorough clinical work-up, and should be limited to cases of suspected inflammatory neuropathies, collagenoses and immunologic neuropathies, and hereditary neuropathies.     

Estrogen as an adjuvant therapy to antipsychotics does not prevent relapse in women suffering from schizophrenia: results of a placebo-controlled double-blind study

The expected therapeutic effect of estrogen as an adjunct treatment to antipsychotics in women suffering from schizophrenia for relapse prevention was to be tested under real-life conditions. A multicenter, randomized, placebo-controlled, double-blind, cross-over study based on an A-B-A-B (and/or B-A-B-A) design was applied. Forty-six hypoestrogenic women with schizophrenia hospitalized for the first time or repeatedly were included in the study. Their average age was 37.9 and they had been suffering from schizophrenia for 8.4 years. During the drug treatment phases, they received a three-phase estrogen-gestagen combination drug (17beta-estradiol+norethisterone acetate) in addition to an antipsychotic drug. Significant effects of the adjuvant hormone replacement therapy on the estradiol levels could be observed, and high and low levels of estradiol prevailed in the active drug and placebo phases, respectively. We did not find any difference either in defined relapse events or in the psychopathology between estradiol replacement and placebo phases. Neither did the required antipsychotic doses or the tolerance data differ between the two phases. Thus, the results of our study do not confirm the hypothesis that a combined estradiol/antipsychotic therapy is superior to an antipsychotic monotherapy for relapse prevention.     

Developing and validating a stress appraisal measure for minority adolescents

Although there are a number of measures designed to assess the cognitive appraisal of stress in adult populations, currently there are no measures that are specifically designed to assess this important construct in adolescents. To overcome this limitation, the factorial validity and dimensionality of a dispositional measure of stress appraisal was examined in the current study. Using a multiethnic adolescent sample, both exploratory and confirmatory factor analyses resulted in a three-factor representation of appraisal. The three factors included two primary appraisal dimensions (Threat and Challenge) and one secondary appraisal dimension (Resources). This three-factor model, however, is inconsistent with four- and six-factor models found previously in adult samples. Thus, these findings suggest that the cognitive appraisals made by adolescents are less complex or differentiated than those of adults. Moreover, these findings suggest that dispositional measures are relevant for adolescent samples and should be incorporated into stress and coping paradigms.     

Surfactant in newborn compared with adolescent pigs: adaptation to neonatal respiration

Surfactant composition and function differ between vertebrates, depending on pulmonary anatomy and respiratory physiology. Because pulmonary development in pigs is similar to that in humans, we investigated surface tension function, composition of phospholipid molecular species, and concentrations of surfactant protein (SP)-A to -D in term newborn pigs (NP) compared with adolescent pigs (AP), using the pulsating bubble surfactometer, mass spectrometry, high-performance liquid chromatography, and immunoblot techniques (IT). NP was more potent than AP surfactant in reaching minimal surface tension values near zero mN/m. Whereas SP-A and SP-D were comparable, SP-B and SP-C were increased 3- to 4-fold in NP surfactant. Moreover, fluidizing phospholipids such as palmitoylmyristoyl-PC (PC16:0/14:0) and palmitoylpalmitoleoyl-PC (PC16:0/16:1) were increased at the expense of PC16:0/16:0 (32.4 +/- 0.6 versus 44.5 +/- 3.2%, respectively). Whereas concentrations of total anionic phospholipids were similar in NP and AP surfactant (9.9 +/- 0.3 and 12.0 +/- 0.3%, respectively), phosphatidylinositol was the predominant anionic phospholipid in NP surfactant. We conclude that, compared with AP, NP surfactant displays better surface tension function under dynamic conditions, which is associated with increased concentrations of SP-B and SP-C, as well as fluidizing phospholipids at the expense of PC16:0/16:0.     

Pathways to self-esteem in late adolescence: the role of parent and peer attachment, empathy, and social behaviours

The goal of this study was to examine both the direct and indirect relations of parent and peer attachment with self-esteem and to examine the potential mediating roles of empathy and social behaviour. 246 college students (M age = 18.6 years, S.D. = 1.61) completed self-report measures of parent and peer attachment, empathy, social behaviour, and self-esteem. Structural equation modelling revealed that parental attachment had mostly direct effects on self-esteem. Among females, the links between peer attachment and self-esteem, however, were entirely mediated by empathy and prosocial behaviour. The findings from this study suggest that although close supportive relationships with parents and peers are related to adolescent self-esteem, these links are complex.     

Questionnaire on parental attitudes and rearing practices (FEPS)

A positive parent-child relationship is one of the most important determinants of a healthy cognitive, emotional and social development. The relationship from parent to child is determined by parenting styles. Parenting styles are characterised by the two dimensions parental attitudes and rearing practices. The development and the psychometric properties of a questionnaire on parental attitudes and rearing practices (FEPS), which contains an extended version of the Parental Bonding Instrument by Parker et al. (PBI, 1979) and two scales on parental reinforcement and punishment behaviour, is presented. In a sample of 457 women and 159 men factorial and item analysis revealed four scales (care, autonomy, low punishment and low material reinforcement). The care dimension contained items of immaterial reinforcement on the positive pole and items of coldness and ignorance as means of punishment on the negative pole. Based on findings from its first application in a clinical study it can be assumed that the FEPS differentiates between clinical and non-clinical populations. Additionally, varying patterns of the four scales may emerge as risk factors for the development of certain psychiatric/psychological problems.