Does resilience mediate the association between mental health symptoms and linguistic markers of trauma processing? Analyzing the narratives of women survivors of intimate partner violence

Intimate partner violence (IPV) is a serious issue for women from all cultures and backgrounds. Studies on the negative consequences of violence suggest that women with a history of abuse are more likely to display depressive and PTSD symptoms. However, recent research has focused on the mechanisms underpinning resilience and the processing of traumatic memories, including linguistic markers and how they may reflect the mental health of traumatized individuals. In this study, we analyzed trauma narratives to investigate whether resilience mediates the impact of PTSD and depression symptoms on five trauma-processing mechanisms (cognitive processing, emotional processing, perceived threat to life, self-perspective, and integration of traumatic memories). Forty-three abused women (mean age = 38.74 years; SD = 9.41) wrote about their traumatic experiences and completed instruments assessing their levels of PTSD, depression, and resilience. We used LIWC software to analyze the women's narratives in terms of linguistic markers of psychological processing. Mediation analysis indicated that resilience fully mediated the impact of mental health symptoms on emotional processing, perceived threat to life, and integration of traumatic memories and partially mediated cognitive processing and self-perspective. We discuss the clinical implications of these findings, emphasizing the need to focus on the resources and strengths of women survivors of abuse in designing targeted psychological interventions.

The Up-Side of the COVID-19 Pandemic: Are Core Belief Violation and Meaning Making Associated with Post-Traumatic Growth?

The negative impact of the COVID-19 pandemic on mental health has been extensively documented, while its possible positive impact on the individual, defined as Post-Traumatic Growth (PTG), has been much less investigated. The present study examines the association between PTG and socio-demographic aspects, pre-pandemic psychological adjustment, stressors directly linked to COVID-19 and four psychological factors theoretically implicated in the change processes (core belief violation, meaning-making, vulnerability and mortality perception). During the second wave of the pandemic 680 medical patients completed an online survey on direct and indirect COVID-19 stressors, health and demographic information, post-traumatic growth, core belief violation, meaning-making capacity, feelings of vulnerability and perceptions of personal mortality. Violation of core beliefs, feelings of vulnerability and mortality, and pre-pandemic mental illness positively correlated with post-traumatic growth. Moreover, the diagnosis of COVID-19, stronger violation of core beliefs, greater meaning-making ability, and lower pre-existing mental illness predicted greater PTG. Finally, a moderating effect of meaning-making ability was found. The clinical implications were discussed.

Linguistic Predictors of Psychological Adjustment in Healthcare Workers during the COVID-19 Pandemic

COVID-19 broke out in China in December 2019 and rapidly became a worldwide pandemic that demanded an extraordinary response from healthcare workers (HCWs). Studies conducted during the pandemic observed severe depression and PTSD in HCWs. Identifying early predictors of mental health disorders in this population is key to informing effective treatment and prevention. The aim of this study was to investigate the power of language-based variables to predict PTSD and depression symptoms in HCWs. One hundred thirty-five HCWs (mean age = 46.34; SD = 10.96) were randomly assigned to one of two writing conditions: expressive writing (EW n = 73) or neutral writing (NW n = 62) and completed three writing sessions. PTSD and depression symptoms were assessed both pre- and post-writing. LIWC was used to analyze linguistic markers of four trauma-related variables (cognitive elaboration, emotional elaboration, perceived threat to life, and self-immersed processing). Changes in PTSD and depression were regressed onto the linguistic markers in hierarchical multiple regression models. The EW group displayed greater changes on the psychological measures and in terms of narrative categories deployed than the NW group. Changes in PTSD symptoms were predicted by cognitive elaboration, emotional elaboration, and perceived threat to life; changes in depression symptoms were predicted by self-immersed processing and cognitive elaboration. Linguistic markers can facilitate the early identification of vulnerability to mental disorders in HCWs involved in public health emergencies. We discuss the clinical implications of these findings.

Social Environment and Attitudes toward COVID-19 Anti-Contagious Measures: An Explorative Study from Italy

Social and cultural aspects (i.e., political decision making, discourses in the public sphere, and people's mindsets) played a crucial role in the ways people responded to the COVID-19 pandemic. Framed with the Semiotic-Cultural Psychological Theory (SCPT), the present work aims to explore how individual ways of making sense of their social environment affected individuals' perception of government measures aimed at managing the pandemic and the adherence to such measures. An online survey was administered from January to April 2021 to the Italian population. Retrieved questionnaires (N = 378) were analyzed through a Multiple Correspondence Analysis (MCA) to detect the factorial dimensions underpinning (dis)similarities in the respondents' ways of interpreting their social environment. Extracted factors were interpreted as markers of Latent Dimensions of Sense (LDSs) organizing respondents' worldviews. Finally, three regression models tested the role of LDSs in supporting the individual satisfaction with the measures adopted to contain the social contagion defined at national level, individual adherence to the containment measures and the perception of the population's adherence to them. Results highlight that all the three measures are associated with a negative view of the social environment characterized by a lack of confidence in public institutions (health system, government), public roles and other people. Findings are discussed on the one hand to shed light on the role of deep-rooted cultural views in defining personal evaluations of government measures and adherence capacity. On the other hand, we suggest that taking into account people's meaning-making can guide public health officials and policy makers to comprehend what favors or hinders adaptive responses to emergencies or social crises.

The mediating effect of cognitive and emotional processing on PTSD and depression symptoms reduction in women victims of IPV

Intimate partner violence (IPV) is a serious social, physical and mental health issue. Women victims of IPV can develop short- and long-term consequences such as depression and post-traumatic stress disorder (PTSD). Where trauma has been incurred, standard psychotherapies may usefully be complemented by interventions based on expressive writing (EW). Numerous studies have explored the mechanisms underpinning improvement after writing, focusing on the cognitive and emotional processing of traumatic experiences. The aims of this study were to evaluate changes in PTSD and depression symptoms following EW and to examine the mediating effect of emotional and cognitive processing on symptom reduction in subjects who engaged in EW. Seventy-seven abused women (mean age = 41.43, SD = 10.75) were randomly assigned to a three-session expressive writing condition (n = 43) or a neutral writing condition (n = 34). Psychological distress (PTSD and depression) was assessed both before and after the writing sessions. Linguistic inquiry word count software was used to analyze the women's narratives in relation to emotional processing (positive and negative emotions) and cognitive processing (insight and causal attributions). The mediation model indicated that the reduction in depression was fully mediated by negative emotion processing and partially mediated by cognitive processing, while the reduction in PTSD was partially mediated by negative emotion processing and fully mediated by cognitive processing. No effect of positive emotion processing was found. The clinical implications are discussed.

Language and Intelligence: A Relationship Supporting the Embodied Cognition Hypothesis

Cognitive science has gathered robust evidence supporting the hypothesis that cognitive processes do not occur in an amodal format but take shape through the activation of the sensorimotor systems of the agent body, which works as simulation system upon which concepts, words, and thought are based. However, studies that have investigated the relationship between language and cognitive processes, as both embedded processes, are very rare. In this study, we investigated the hypothesis that intelligence is associated with referential competence, conceived as the ability to find words to refer to our subjective and perceptual experience, and to evoke understanding of this experience in the listener. We administered the WAIS-IV test to 32 nonclinical subjects and collected autobiographical narratives from them through the Relationship Anecdotes Paradigm Interview. The narratives were analyzed linguistically by applying computerized measures of referential competence. Intelligence scores were found to correlate with the use in narratives of words related to somatic and sensory sensations, while they were not associated with other measures of referential competence related to more abstract domains of experience or based on vivid or reflective dimensions of language style. The results support the hypothesis that sensorimotor schemas have an intrinsic role in language and cognition.

Play-Based Activities with a CoderBot Robot on a Pediatric Ward: A Case Study

Being hospitalized is a threatening and stressful experience for many children. From a psychological point of view, children may experience increased feelings of anxiety and fear that can negatively influence their behavioral, cognitive, and emotional outcomes. To mitigate such adverse effects on children’s mental health and well-being, interventions that might contribute to protecting the emotional domain of hospitalized children are welcome. The present case study of a single-setting intervention allowed us to evaluate the impact, on children admitted to a pediatric short-term recovery ward (N = 61), of participating in play-based activities with a CoderBot robot. The methodology spanned multiple data sources (children, parents, nurses), field observation, and a sequential (quantitative–qualitative) mixed-method approach to data analysis. We found that robot-based activities are associated with enhanced well-being (particularly positive emotions). Both the participating children and their caregivers reported that the activity was enjoyable and interesting, especially thanks to its technologically innovative nature. We critically discuss these positive findings in relation to the strengths of our pilot study, as well as its contextual and methodological limitations, and outline possible future lines of development for this kind of project.

Assessing Family Functioning Before and After an Integrated Multidisciplinary Family Treatment for Adolescents With Restrictive Eating Disorders

Introduction

Previous studies applying the Lausanne Trilogue Play (LTPc), a semi-structured method for observing family dynamics, highlighted dysfunctional interaction patterns in the families of individuals affected by restrictive eating disorders (REDs). Family-centered approaches are considered the first-line treatment for severe cases of REDs in adolescence.

Objectives

To investigate family functioning in the families of adolescents with severe REDs assessed before and 6 months after a multidisciplinary family treatment program that combined psychodynamic psychotherapy, parental role intervention and triadic or family-centered intervention.

Methods

Sixty-seven families of adolescent patients diagnosed with REDs were assessed for eligibility between July 2017 and October 2020. Family functioning was assessed using the clinical version of LTPc. Nutritional counseling and neuropsychiatric monitoring were also provided.

Results

We observed a significant change in the family functioning score for the LTPc phase 2, in which the father interacts with his daughter while the mother acts as a silent observer. This suggests that the fathers, when playing an active role, could improve dyadic family functioning. The treatment was not found to change triadic functioning: a 6-month treatment may not be long enough to modify interactions at the triadic level.

Conclusions

A brief multidisciplinary treatment program may significantly improve family functioning in the families of patients diagnosed with severe REDs. Although appropriate clinical trials are needed to further test the efficacy of this treatment, our study reinforce the concept that treatment programs targeting the individual patient and both the parents should be a first-line approach in adolescents with severe REDs.

Disclosure

The authors declare that they do not have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstrac.

Peripheral inflammation exacerbates α-synuclein toxicity and neuropathology in Parkinson's models

AIMS

Parkinson's disease and related disorders are devastating neurodegenerative pathologies. Since α-synuclein was identified as a main component of Lewy bodies and neurites, efforts have been made to clarify the pathogenic mechanisms of α-synuclein's detrimental effects. α-synuclein oligomers are the most harmful species and may recruit and activate glial cells. Inflammation is emerging as a bridge between genetic susceptibility and environmental factors co-fostering Parkinson's disease. However, direct evidence linking inflammation to the harmful activities of α-synuclein oligomers or to the Parkinson's disease behavioural phenotype is lacking.

METHODS

To clarify whether neuroinflammation influences Parkinson's disease pathogenesis, we developed: (i) a 'double-hit' approach in C57BL/6 naive mice where peripherally administered lipopolysaccharides were followed by intracerebroventricular injection of an inactive oligomer dose; (ii) a transgenic 'double-hit' model where lipopolysaccharides were given to A53T α-synuclein transgenic Parkinson's disease mice.

RESULTS

Lipopolysaccharides induced a long-lasting neuroinflammatory response which facilitated the detrimental cognitive activities of oligomers. LPS-activated microglia and astrocytes responded differently to the oligomers with microglia activating further and acquiring a pro-inflammatory M1 phenotype, while astrocytes atrophied. In the transgenic 'double-hit' A53T mouse model, lipopolysaccharides aggravated cognitive deficits and increased microgliosis. Again, astrocytes responded differently to the double challenge. These findings indicate that peripherally induced neuroinflammation potentiates the α-synuclein oligomer's actions and aggravates cognitive deficits in A53T mice.

CONCLUSIONS

The fine management of both peripheral and central inflammation may offer a promising therapeutic approach to prevent or slow down some behavioural aspects in α-synucleinopathies.

Fostering the Reconstruction of Meaning Among the General Population During the COVID-19 Pandemic

The COVID-19 outbreak has seen people in many countries asked to radically modify their way of life in compliance with sweeping safety measures. During the current crisis, technology is turning out to be key, in that it allows practitioners to deliver psychological services to people who would otherwise be unreachable. However, professionals cannot solely rely on their traditional modes of practice, in that different methods are required to bring to light the needs of those affected by the emergency. People are being overwhelmed by a cascade of unusual and unexpected events that are putting a strain on their everyday routines and usual meaning-making systems; ongoing challenges to their employment and financial status will likely divert personal resources away from psychological well-being. We therefore argue that psychologists should also consider the needs of the general population. Among those who may require help-aside from the main targets of psychological intervention, such as healthcare personnel and COVID-19 patients and their relatives-specific attention should be paid to those who are not at the center of the crisis. We suggest that this large segment of potential users may benefit from a non-medical approach focused on the promotion of meaning-making processes. Indeed, the disruptive nature of the current situation hinders sense-making and threatens to undermine psychological balance and well-being, at an individual as well as at a societal level. The present article proposes a methodological perspective based on the reconstruction of meaning-making processes (sense of coherence, predictability, metaphors, narratives). Specifically, psychological interventions should promote personal and collective resources with a view to: "normalizing" current distressful experiences (i.e., acknowledging that such reactions are normal in light of the present situation); widening the observational field, taking relational contexts into account, and promoting an understanding of distressful experiences as coping strategies; fostering meaning-making/reconstruction processes through the use of appropriate metaphors and narratives; promoting a sense of coherence. We present two clinical vignettes to illustrate how these principles might be applied in practice. In conclusion, the exceptional psychological challenges posed by the COVID-19 pandemic require practitioners to adopt a broad and flexible perspective on clinical intervention.

Alliance portfolio classification. Which portfolio do you have?

Purpose

The purpose of this article is to propose and discuss a systematic theoretical classification of alliance portfolios that allows to elucidate and develop the concept.

Design/methodology/approach

The study applies a conceptual approach. A review of the literature was carried out to support the conclusions of this paper.

Findings

The results of the classification identify three types of alliance portfolio, according to the level of management that each of them requires: additive, strategic and managed and strategic. These portfolio typologies are analyzed in an evolutionary perspective.

Practical implications

This article is of interest to managers as it emphasizes the management of the alliance portfolio, highlighting the elements or characteristics that determine the transition from one type of portfolio to another.

Originality/value

This paper contributes to the consolidation and reorientation of the extensive research into alliance portfolios and proposes a systematic classification that can help to interpret the results of research and guide future studies.

The impact of perinatal loss in maternity units: A psycholinguistic analysis of health professionals' reactions

Perinatal loss has a strong emotional impact on health professionals working in maternity units. We aimed to study the impact of this experience on health professionals' language. We analyzed the answers of 162 health professionals (physicians and non-medical staff) who described their reactions to perinatal loss. A linguistic analysis was performed using the Linguistic Inquiry and Word Count software. Associations between language and burnout were studied. Words typical of a psychological shock reaction were used more by non-medical staff than by physicians. Participants who used pronouns, optimistic words, future tense verbs, and cognitive words registered lower levels of burnout. Clinical implications of the results are discussed.

Toward psychiatry as a 'human' science of mind. The case of depressive disorders in DSM-5

The aim of this paper is to argue that a strictly reductionist approach to psychiatry represents a theoretical and clinical obstacle to a fruitful synthesis between neurobiological and sociocultural aspects of the sciences of mind. We examine the theoretical and practical motivations underlying this approach, by analyzing the case of depressive disorders, as defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the related removal of the "bereavement exclusion clause." We first explore the claim that DSM is atheoretical, observing that, far from being atheoretical, DSM adopts an implicit, biologically inspired view of the mind; we show that such a view leads to a sort of circularity in the definition of depressive disorders, in which psychopharmacology seems to play a key role. We then turn to further problems deriving from this position, analyzing the issue of placebo effects in the treatment of depressive disorders and the philosophical question of normative preconditions for psychopathological diagnosis. Finally, we address the issue of subjectivity, which, together with the related aspect of the subject's relational context, appears to be crucial to any scientific theorizing about mental disorders, despite DSM's attempt to exclude it. Our defense of a non-reductionist view of mental disorders, however, does not imply that we endorse any sort of metaphysical dualism, or anti-diagnostic or anti-psychiatric positions. On the contrary, we argue that the adoption of a reductionist position actually undermines the theoretical and clinical accuracy in explaining depressive disorders.

Cost of a population-based programme of chest x-ray screening for lung cancer

BACKGROUND

After the implementation of a population-based programme of chest x-ray (CXR) screening on smokers in Varese, Italy, lung cancer (LC) mortality was significantly reduced. Analysis of the incremental costs due to this type of screening programme is needed to evaluate its economic impact on the healthcare system.

METHODS

In July 1997 a population-based cohort, consisting of all high-risk smokers (n=5,815) identified among 60,000 adult residents from the Varese province, was invited to a LC screening programme (an annual CXR for five years) in a general practice setting, and was observed through 2006. Invitees received National Health Service (NHS) usual care, with the addition of CXRs in screening participants. At the end of observation, among the 245 LCs diagnosed in the entire screening-invited cohort the observed LC deaths were 38 fewer than expected. To estimate the incremental direct cost due to screening in the invited cohort for the period July 1997-2006, we compared the direct cost of screening administration, CXR screens and LC management in the invited cohort and in the uninvited and unscreened controls in NHS usual care setting.

RESULTS

Over the 9.5 years, the total incremental direct healthcare costs (including screening organization/administration, CXR screens, additional procedures prompted by false-positive tests, overdiagnosed LCs) were estimated to range from euro 607,440 to euro 618,370 (in euros as of 2012), equating to between euro 15,985- euro 16,273 per patient out of the 38 LC deaths averted.

CONCLUSIONS

In a general practice setting, the incremental cost for a CXR screening programme targeted at all high-risk smokers in a population of 60,000 adults was estimated to be about euro 65,000 per annum, approx. euro 16,000 for each LC death averted.

Self-Other Positioning in Obesity: A Pilot Study Using Repertory Grid Technique

Self-other positioning was investigated in a group of obese youths in order to empirically test the clinical hy-pothesis – based on the constructionist theory of Family Semantic Polarities – that obese people are affected by a negative self-perception and low self-esteem. Repertory grid technique was used with 30 participants (15 obese-overweight and 15 control) to elicit and compare their personal constructs and assess, via ad hoc measurement indices, the positions they as- signed to the self and significant others in relation to these constructs. The results confirmed the research hypotheses, with obese subjects displaying a tendency to pos ition both self and others at the negative pole of bipolar constructs and reporting greater self-ideal discrepancy. These findings and their limitations are discussed in relation to their clinical applications and in light of the methodologi cal issues arising from the study.

Psychopathological Organizations and Attachment Styles in Patients with Fear of Flying: A Case Study

Objectives:

The scope of the study is to identify the leading “organization of meaning” in patients affected by aviophobia and the related attachment style. Specifically we hypothesized that participants with fear of flying would predominantly display a phobic organization of meaning, associated with an anxious-ambivalent attachment style.

Methods:

150 adults, divided between an experimental group (FOF) and a control group (CON), completed three research instruments: two self-report questionnaires assessing attachment style (AAQ and ASQ) and the self-characterization, a qualitative constructivist tool.

Results:

The insecure attachment style prevailed in aviophobics rather than control group. Socio-economic and gender differences were found. The vocabulary used by the group with flying phobia featured a system of meaning referring to “freedom” family semantics.

Conclusions:

Attachment style appears to be a necessary but insufficient condition for predicting fear of flying. A greater role in the disorder is played by the organization of patients' personality, as argued by socio-constructionist and constructivist authors. Implication for clinical work and psychotherapy are discussed.

Cost of reproduction. Changes in metabolism and endosulfan lethality caused by reproductive behavior in Hyalella curvispina (Crustacea: Amphipoda)

Biocides are periodically applied in agricultural activities, reaching aquatic systems and acting upon the biota. Amphipods are widely used in toxicity tests because of their sensitivity to a wide range of pollutants. In this work, we report the differential lethality of a widely used pesticide, endosulfan, on the amphipod Hyalella curvispina at two life stages and in three different adult groups, males and females separated by sex and both sexes grouped together. In addition, oxygen consumption of adult groups was determined as a way to estimate the role of behavioral activities and exposure to endosulfan in metabolism shifts. There were no differences between the LC(50) of juveniles and the adults when they were separated by sex (p>0.05). Nevertheless, the LC(50) of adults without sexual differentiation was significantly lower than the LC(50) of juveniles and adults separated by sex (p<0.05). The oxygen consumption rate was higher when adults were grouped without sexual differentiation in the control group. The exposure to low concentrations of endosulfan causes an increase in oxygen consumption in all the treatments. The sexual behavior increased the metabolism and the sensitivity to endosulfan. In future evaluations, adults grouped without sexual differentiation, which were the most sensitive group, should be included in order to mimic the environmental conditions. Using only juveniles or adults separated by sex in toxicity tests may inaccurately estimate the lethality of biocides, especially in species with constant reproductive activities.

Bullous lung disease and neurofibromatosis type-1

Lung interstitial diseases and bullae are described as possible complications of neurofibromatosis type-1 (NF-1), a genetic disorder inherited as a autosomal-dominant trait. We report the case of a 16-year-old male non-smoker with NF-1, who presented with pneumothorax caused by ruptured lung bullae. The case of this young patient, successfully treated by video-assisted thoracoscopic resection of bullae, supports the concept that pulmonary alterations may be part of the NF-1 syndrome, rather than as an unrelated complication.

'My happiness is the refugee camp, my future Palestine': optimism, life satisfaction and perceived happiness in a group of Palestinian children

BACKGROUND

This study aimed to explore optimism, perceived happiness and life satisfaction in a group of Palestinian children living in urban districts, rural areas and a refugee camp in the West Bank, as well as in a city in Israel.

METHOD

Three self-report instruments were administered to a convenience sample of school-age children (n. 226; 8-12 years old): the Youth Life Orientation Test (YLOT), the Subjective Happiness Scale (SHS) and the Face Scale (FS). The scores were analyzed using anovas and correlation tests (Pearson's r). Gender and age differences were explored.

RESULTS

Optimism, life satisfaction and perceived happiness characterize the entire group of Palestinian children in general. Very little difference was found as a function of gender.

CONCLUSION

Palestinian children seem to enjoy a satisfactory quality of life with regard to optimism, satisfaction and perceived happiness. We hypothesize that these factors may reinforce resilience and positive adjustment to trauma in children. The implications for clinical psychology are discussed.

Fasting hyperglycaemia and in-hospital mortality in elderly population

BACKGROUND

Admission hyperglycaemia has shown to be a marker of poor clinical outcome. The prevalence of admission hyperglycaemia and its relationship with in-hospital mortality in elderly population has not been clearly defined. We assessed the prevalence and prognostic significance of admission fasting hyperglycaemia in aged patients.

METHODS

A total of 808 elderly patients were studied. Patients were classified into group I (serum glucose < 126 mg/dl), II (126-180 mg/dl) and III (> 180 mg/dl). Groups II and III were considered newly recognised fasting hyperglycaemia (NRFH) in non-diabetic patients.

RESULTS

NRFH was present in 18.6%. After excluding diabetic patients (n = 206, 25.5%), the distribution of patients (n = 602, 74.5%) was as follows: group I (n = 452, 55.9%), group II (n = 122, 15.1%) and group III (n = 28, 3.5%). In the whole cohort, median fasting glucose was lower in patients who survived [105 mg/dl (88-135)] than in those who died [127 mg/dl (93-159), p < 0.001]. This significant difference was maintained only when non-diabetic patients were considered [100 mg/dl (87-122) vs. 118 mg/dl (92-149), p < 0.001]. In-hospital mortality rate in groups I, II and III was 8.5%, 14.1% and 22.9%, respectively (p < 0.001). Mortality rate was 8.4%, 18.0% and 32.1% (p < 0.001) in groups I, II and III, respectively in non-diabetic population. Both low albumin and high glucose serum concentrations were the only independent risk factors for in-hospital all-cause mortality in non-diabetic patients.

CONCLUSIONS

In non-diabetic elderly patients admitted for acute disease, serum glucose concentration is an important, simple and independent predictor of hospital mortality.

[Extramedullary hematopoyesis: compensatory mechanism or clinic syndrome? Case report and review of literature]

Extramedullary hematopoiesis (EMH) is a compensatory mechanism occurring in patients with chronic anemia. Liver, spleen, and lymph nodes are frequently involved. However, EMH may also develop in several sites such as thymus, kidneys, retroperitoneum, paravertebral areas of the thorax, lungs, bowel and others. Rarely symptomatic, it often shows a variety of clinical features. This condition, frequently, may be fatal. A correct early diagnosis of EHM might avoid, if possible, a bad prognosis. The Authors report a case where bone marrow cells were identified in centrifuge cerebrospinal fluid of a patient suffering from non-Hodgkin lymphoma.

Visceral leishmaniasis in a patient treated for polyarteritis nodosa

We report a case of visceral leishmaniasis in a patient receiving steroids and cyclophosphamide for polyarteritis nodosa. The clinical presentation of leishmaniasis, with fever, pancitopenia and hypergammaglobulinemia may be confused with a reactivation of vasculitis or with other non-infectious conditions such as haematologic diseases. In endemic areas, the case of latent leishmaniasis must be considered and serology for Leishmania should be performed before starting immunosuppressive treatment.

[Continence problems after radical prostatectomy: medical treatment]

OBJECTIVE

We hypothesized that a benefit can be obtained from both urine storage and urethral resistance after retropubic radical prostatectomy through the induction of artificial erections.

MATERIAL AND METHODS

From January 1993 to December 2000 we have submitted 127 patients to radical retropubic prostatectomy. According to preoperative bladder behaviour, 59 patients (46.5%) presented voiding disorders, 10 (7.9%) filling disorders, 4 (3.1%) mixed disorders, whereas 54 (42.5%) were asymptomatic. The urethral catheter was removed between the 10th and the 12th postoperative day. Fourteen patients entered a programme of early sexual rehabilitation with intracavernous injection of prostaglandin E1 (ICI) within 7 days from catheter removal.

RESULTS

After catheter removal the recovery of urinary continence occurred within 2.2 +/- 2.3 days. At dismissal from the hospital, 8 patients (6.2%) were almost totally incontinent; 2 (1.5%) were still incontinent after a 6-month period; 73 (57.4%) were dismissed with clinical signs of detrusor instability hence treated with anticholinergic drugs such oxybutynin or tolterodine; 3 (2.3%) resulted obstructed after surgery because of stenosis of the anastomosis. Almost all the patients submitted to early sexual rehabilitation referred an improvement of their incontinence after the first injection. The patients who did not begin an early sexual rehabilitation generally recovered from incontinence in a longer time.

CONCLUSIONS

Our preliminary observations showed that artificial erection PGE1-induced is effective in improving or accelerating post radical prostatectomy incontinence recovery. The results apply also to patients with pre-operatory detrusor instability.

[Endoscopic surgery in day hospital using bladder and urethral anesthesia with EMDA]

PURPOSE

To assess the suitability of EMDA local anaesthesia for invasive procedures on lower urinary tract in one day surgery treatment.

PATIENTS AND METHODS

The deep penetration of lignocaine into the bladder wall was attained by catheters, electrodes and electric current generators using revised electrochemical principles. Since 1994 203 patients with transitional cell carcinoma of the bladder underwent TURBT and 70 patients with bladder neck or prostatic obstruction underwent TURP, TUIP, TULAP; 20 patients underwent miscellaneous procedures: in 34 patients the procedures were combined. The patients' age was within 20 and 90 years (mean age 67.3). The procedures were performed in a single small endoscopic theatre annexed to the Urology Ward. A standard rigid resectoscope was used as well as a standard electrocautery (360 kHz) or a mega frequency low temperature Vesalius generator (4 MHz). Most patients received a premedication and some of them a light sedation when necessary, but all of them were fully conscious and able to complete an assessment using a simple pain scale.

RESULTS

8 out of 273 patients (3%) considered pain intolerable and other 11 (4%) reported painful but tolerable sensation, and the remaining 254 patients referred absent or minimal discomfort. Most of the patients were able to walk back to their room and go home in the evening. Those who had no chance of going back home were admitted for the night as well as those who had no assistance at all at home or those who had high probability of haemorrhage. Side effects were minimal and not related to local anesthesia: the serum lignocaine levels measured in 4 patients were innocuous. All patients experienced some tingling and reddening at the skin site of the dispersive electrode fading in a few hours.

CONCLUSIONS

Local anaesthesia by using EMDA proved to be effective for most invasive endoscopic procedures in the lower urinary tract and suitable for patients undergoing day hospital surgery.

[Amyotrophic lateral sclerosis in a patient with Waldenstrom's macroglobulinemia]

Although a peripheral neuropathy is the best known neurological complication of Waldenstrom's Macroglobulinemia (WM), the association of Amyotrophic Lateral Sclerosis (ALS), or other Motor Neuron Diseases (MND) with monoclonal gammopathies is described. We report the case of a male patient (41 years old) with WM and ALS. Whether monoclonal gammopathies play a role in the pathogenesis of MND is unclear but is la possible that patients might have antibodies against motor neurons. In our reported case neurologic symptoms were the first and the most important manifestations of the underlying hemopathy and despite plasmapheresis and immunosuppressive treatment ALS syndrome progressed. The neurologic disease worsened despite the improvement of WM.

Low prevalence of islet autoantibodies in patients with gestational diabetes mellitus

OBJECTIVE

To determine the proportion of patients with gestational diabetes mellitus (GDM) who have serological characteristics typical of IDDM.

RESEARCH DESIGN AND METHODS

Islet cell antibodies (ICAs), insulin autoantibodies (IAAs), GAD65, and IA-2 antibodies were measured in 145 pregnant women with GDM, 33 with impaired glucose tolerance (IGT), and in 73 with normal glucose tolerance (NGT). ICAs were measured by indirect immunofluorescence; GAD65 and IA-2 antibodies, by a radio-ligand immunoassay incorporating 35S-labeled recombinant antigen; and IAAs, by a liquid-phase radiobinding assay.

RESULTS

The prevalences of islet autoantibodies were low and not significantly different between groups. ICAs were detected at levels ranging from 5 to 45 Juvenile Diabetes Foundation U in 14 (10%) women with GDM, 2 (6%) women with (GT, and in 4 (5%) women with NGT. IAAs were detected at levels between 3 and 4 SD above the mean in 4 (3%) women with GDM, 0 women with IGT, and in 1 (1%) woman with NGT. None had both ICAs and IAAs. Neither GAD65 nor IA-2 antibodies, which have been detected in the majority of pre-IDDM and IDDM patients, were found in NGT, IGT, or GDM patients.

CONCLUSIONS

Low-titer ICAs and IAAs are not infrequent in pregnant women, but multiple islet autoantibodies and antibodies to GAD65 or IA-2 were not found in GDM. These findings suggest that the serological characteristics of IDDM are rare in GDM.

Insulin antibodies do not preclude optimization of metabolic control in women with IDDM during pregnancy

OBJECTIVE

To evaluate whether the presence of insulin antibodies (IAs) may preclude the optimization of metabolic control during pregnancy and affect outcome in women with IDDM.

RESEARCH DESIGN AND METHODS

IAs were measured by radiobinding assay in 44 women with IDDM referred to the Diabetes and Pregnancy Outpatients' Clinic during 46 pregnancies. Age, duration of IDDM, metabolic control (HbA1c, mean pre- and postprandial capillary blood glucose, frequency of hypo- or hyperglycemia), insulin requirement at 1st and 3rd trimester of pregnancy, BM1, and weight gain were recorded. Neonatal variables such as gestational age, weight, length, and the presence at birth of either hypoglycemia, hypocalcemia, or jaundice requiring phototherapy were also considered.

RESULTS

IAs correlated positively with insulin requirement (P < 0.05) and negatively with HbA1c at term (P < 0.01). Patients with IA levels > or = 40% insulin binding (8 of 46) had a higher insulin requirement and lower preprandial capillary blood glucose at the beginning of pregnancy but not at term (P < 0.005), whereas they had lower HbA1c at term than did patients with low IA levels (P < 0.01). IA levels decreased slightly at term (P = 0.007). IA levels > or = 40% were not associated with a higher rate of hypo- or hyperglycemic episodes or with diabetic complications or thyreopathy. No correlation was found between 1A levels and any of the neonatal variables considered.

CONCLUSIONS

The presence of IAs does not preclude optimization of metabolic control during pregnancy and is compatible with a favourable outcome.

Glutathione conjugation with 1-chloro-2,4-dinitrobenzene (CDNB): interindividual variability in human liver, lung, kidney and intestine

The rate of glutathione conjugation with 1-chloro-2,4-dinitrobenzene (CDNB) was measured in specimens of human liver (n = 93), sigmoid colon (n = 56), renal cortex (n = 67) and lung (n = 68). In the liver there was a weak but significant (r = - 0.247 p = 0.017) negative correlation between the activity of glutathione transferase and the liver donor's age. Such a correlation was not found in the renal cortex, lung and colon. In the renal cortex and in lung the rate of glutathione conjugation with CDNB was a little but significantly (p < 0.05) higher in women than men, whereas no sex-dependent difference was observed in the liver and colon. The distribution of glutathione transferase activity was polymorphic in the mucosa of colon and renal cortex of men but not in that of women. Smoking seems not to affect the glutathione conjugation rate with CDNB in lung. The activity of glutathione transferase was 2-, 6-, and 7-fold greater in liver than in the renal cortex, lung and colon, respectively. There was a large interindividual variability of the hepatic glutathione transferase activity, and because this variability, 15% of the population studied catalyzed the glutathione conjugation with CDNB at a rate similar to those of the renal cortex and duodenum. The subjects with low expression of the hepatic glutathione transferase should be more exposed to the effects of toxic and carcinogenic compounds.