Inpatient treatment of children with multiple personality/dissociative disorders and their families

A number of children who are admitted for inpatient psychiatric treatment have experienced significant trauma and abuse. It is important to evaluate them for the presence of a DD. The variety, complexity, and subtlety of the symptomatic presentation of childhood MPD makes differential diagnosis difficult, and it is probable that many cases have been missed in the past. Detailed historical information and extensive behavioral observations in a variety of settings can assist in establishing the diagnosis and in delineating areas for therapeutic intervention. Hospitalization may be necessary to conduct an adequate evaluation, develop a therapeutic alliance, safely manage behaviors that are injurious to the child or others, and/or to diffuse potentially volatile family situations. All members of a multidisciplinary inpatient team play important roles in the achievement of successful therapeutic intervention with dissociating children and their families. Skilled family therapy is often an important adjunct to therapeutic interventions focused on the child, particularly when the parent also has MPD. Knowledge of the psychodynamic issues involved in dissociation can be used to develop behavioral interventions that are successful in decreasing the child's need to dissociate, improving his or her overall functioning, and help him or her gain mastery over problematic behaviors.     

The effect of baseline complex ovarian cysts on in vitro fertilization outcome.

STUDY OBJECTIVE: To determine the effect of baseline complex ovarian cysts on controlled ovarian hyperstimulation and in vitro fertilization (IVF) outcome. DESIGN: Retrospective analysis with stratification by stimulation regimen and the presence or absence of surgically documented endometriosis. PATIENTS: Two hundred sixty-one women undergoing IVF from May 1, 1989 to December 31, 1990. MAIN OUTCOME MEASURES: The outcome measures assessed were the maximum estradiol (E2) concentration on day of human chorionic gonadotropin (hCG) administration, number of follicles with maximum diameter greater than or equal to 15 mm, number of follicles with maximum diameter greater than or equal to 12 mm, number of days to hCG administration, number of ampules of human menopausal gonadotropin (hMG) used, number of oocytes retrieved and fertilized, number of embryos transferred, and pregnancy and cycle cancellation rates. RESULTS: There were no statistical differences between cyst and noncyst groups in any of the above parameters of IVF performance. In a single subgroup, patients with endometriosis stimulated with hMG and patients with cysts had significantly lower E2 concentrations than patients without cysts. CONCLUSION: The presence of a complex cyst on a baseline ultrasound does not appear to adversely affect IVF cycle outcomes.     

Disorders of thermoregulation in adaptation to external cold and heat stimuli in patients with atopic eczema

Patients suffering from atopic eczema (AE) often exhibit disturbances of various neurovegetative (in particular, vasomotoric) skin functions. Thus, in 21 patients with AE we studied the response of the skin of one forearm to standardized 15-min exposure of the other arm to a cold and a warm bath (17 degrees-18 degrees C and 40 degrees-41 degrees C respectively). The results were compared with those in 23 age- and sex-matched healthy controls under similar environmental conditions. In most patients, during exposure of one forearm to warmth the skin temperature of the contralateral forearm remained unchanged or decreased slightly, whereas exposure to cold induced either a slight rise in skin temperature or an almost indiscernible decrease. In contrast to the normal temperature reaction of the non-exposed forearm to warmth exposure of the contralateral arm in most controls, our findings in atopic patients indicated a "rigid" or even "paradoxical" response to thermic stimuli. This abnormal pattern of thermoregulation may reflect an intrinsic disturbance of the peripheral and hypothalamic autonomous system involved in the pathogenetic conditions of AE.     

Expression of transforming growth factor type beta on human epidermal dendritic cells.

Our study demonstrates that epidermal Langerhans cells (LC) of healthy human skin produce Transforming growth factor-beta (TGF-beta). This multipotent mediator might keep the immunocompetent LC in an "immature" stage, in which they are able to capture and process antigen. Development to potent antigen-presenting cells would become possible after migration from the epidermal network to the draining lymph node to stimulate (auto-)reactive T-cell clones.     

Smoking induces oxidative stress inside the Graafian follicle

BACKGROUND: A growing body of evidence indicates that pro-oxidant/antioxidant balance inside ovarian follicles plays an important role in folliculogenesis. Over 20% of women of reproductive age in Europe and the USA regularly smoke cigarettes. The impact of tobacco smoking on the intrafollicular markers of oxidative stress has not been fully elucidated. The objective of the present study was to test the hypothesis that cigarette smoking affects the intrafollicular redox milieu. METHODS: In follicular fluid samples originating from 108 IVF patients, lipid peroxidation was assessed by the thiobarbituric reactive substances method and total antioxidative capacity was quantified by the luminol enhanced chemiluminescence method. The level of patients' exposure to the cigarette smoke was evaluated by measuring the follicular fluid cotinine concentration by means of radioimmunoassay. RESULTS: Intrafollicular exposure to cigarette smoke metabolites was associated with a significant increase in follicular lipid peroxidation intensity (P < 0.001), which was accompanied by a significant decrease in the local antioxidative potential (P = 0.004). CONCLUSION: The results indicate that active smoking affects the pro-oxidant/antioxidant balance inside the pre-ovulatory ovarian follicle by inducing intrafollicular oxidative stress. This provides another possible explanation for impaired folliculogenesis in female smokers.     

Remarks and recommendations on the definition and classification of eczematous diseases

Numerous nomenclatures and classifications of eczemas have puzzled dermatologists for a long time. This confusion is due to the great number of external as well as internal noxious factors and/or agents causing eczemas being themselves a distinct and histologically well defined reaction of the papillary-epidermal compartment. Current classifications do not adequately reflect the complex causative conditions involved in the etiopathogenesis of eczematous disorders. I propose, therefore, to classify eczematous disorders according to the following three principal categories: "mainly endogenous" (or "atopic") eczemas, "mainly exogenous" (or "contact") eczemas, and "dysregulatory microbial" eczemas. The latter group comprises eczemas caused by various kinds of functional derangement of epidermal protective properties (e.g., venous stasis, exsiccation of horny layer, seborrhea/hyperhidrosis, epidermal atrophy), which in turn permit the resident and/or transient microflora of the horny layer to induce inflammatory responses of eczematous pattern. Since morphological, topical, and other clinical attributes may change in the course of the very same eczematous disease, they are inappropriate for basic classification of eczemas and should be only employed as minor criteria to characterize the predominant "type" or subset (i.e., clinical appearance) of the specific eczema. The possible combination of eczemas representing two (or even three) categories in one patient leads to intermediate forms entirely in keeping with the division into three principal groups. The classification proposed is aimed at eliminating the terminological confusion as well as enabling reliable documentation for compatible statistics, and should consequently improve the sematic communication between dermatologists and other physicians.