Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study

Twelve children with obstetric paralysis were diagnosed as having a posterior dislocation of the humeral head. The diagnosis was suspected on clinical grounds and confirmed by computed tomography (CT) scans in all cases. All 12 patients were treated with open reduction via an anterior approach. The age range at the time of surgery was from 7 months to 7 years (average, 2 years and 3 months). All patients were immobilized in a shoulder spica for 6 weeks and a further 6 weeks in an orthosis. All patients were examined by CT scans in the postoperative period, which confirmed a satisfactory reduction in all cases. With a minimal follow-up of 12 months, there have been no redislocations. This article demonstrates that dislocation of the shoulder in association with obstetric paralysis is not rare, as previously described, and shows that once diagnosed, the dislocation can be satisfactorily treated by a single anterior open reduction of the shoulder.     

Dynamics of tremor-related oscillations in the human globus pallidus: a single case study

Physiological evidence indicates that the resting tremor of Parkinson's disease originates in oscillatory neural activity in the forebrain, but it is unknown whether that activity is globally synchronized or consists of parallel, independently oscillating circuits. In the present study, we used dual microelectrodes to record tremor-related neuronal activity from eight sites in the internal segment of the globus pallidus (GPi) from an awake Parkinson's disease patient undergoing stereotaxic pallidotomy. We utilized spectral analysis to evaluate the temporal correlations between multiunit activity at spatially separated sites and between neural and limb electromyographic activity. We observed that some GPi neural pairs oscillated synchronously at the tremor frequency, whereas other neural pairs oscillated independently. Additionally, we found that GPi tremor-related activity at a given site could fluctuate between states of synchronization and independence with respect to upper limb tremor. Consistent with this finding, some paired recording sites within GPi showed periods of transient synchronization. These observations support the hypothesis of independent tremor-generating circuits whose coupling can fluctuate over time.     

The spiritual work of the dying: a framework and case studies

This article describes a systematic approach to understanding the spiritual work of the dying. It begins by defining "spirituality," "spiritual care" and "spiritual work" in order to create a common vocabulary. The remainder of the article uses vignettes from clinical experience to create a framework for understanding not only the recurrent themes in the spiritual work being done by the terminally ill but the support and interventions of the spiritual counselor as well. These case experiences are clustered under four headings: "remembering," "reassessing," "reconciliation" and "reunion." The article gives serious attention to the "supernatural" experiences of the dying as experienced by the hospice team.     

Dissolution of fused identity in one therapeutic session: A case study.

Describes the treatment in 1 session of 3 undergraduate women who claimed that their identities had merged. A social-cognitive strategy of therapy was employed, emphasizing the use of dissonant persuasive communications and a therapeutic double bind. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Always single and single again women: a qualitative study

This study reports the effects of a novel polyunsaturated 3-thia fatty acid, methyl 3-thiaoctadeca-6,9,12,15-tetraenoate on serum lipids and key enzymes in hepatic fatty acid metabolism compared to a saturated 3-thia fatty acid, tetradecylthioacetic acid. Palmitic acid treated rats served as controls. Fatty acids were administered by gavage in daily doses of 150 mg/kg body weight for 10 days. The aim of the present study was: (a) To investigate the effect of a polyunsaturated 3-thia fatty acid ester, methyl 3-thiaoctadeca-6,9,12,15-tetraenoate on plasma lipids in normolipidemic rats: (b) to verify whether the lipid-lowering effect could be consistent with enhanced fatty acid oxidation: and (c) to study whether decreased activity of esterifying enzymes and diversion to phospholipid synthesis is a concerted mechanism in limiting the availability of free fatty acid as a substrate for hepatic triglyceride formation. Repeated administration of the polyunsaturated 3-thia fatty acid ester for 10 days resulted in a reduction of plasma triglycerides (40%), cholesterol (33%) and phospholipids (20%) compared to controls. Administration of polyunsaturated and saturated 3-thia fatty acids (daily doses of 150 mg/kg body weight) reduced levels of lipids to a similar extent and followed about the same time-course. Both mitochondrial and peroxisomal fatty acid oxidation increased (1.4-fold- and 4.2-fold, respectively) and significantly increased activities of carnitine palmitoyltransferase (CPT) (1.6-fold), 2,4-dienoyl-CoA reductase (1.2-fold) and fatty acyl-CoA oxidase (3.0-fold) were observed in polyunsaturated 3-thia fatty acid treated animals. This was accompanied by increased CPT-II mRNA (1.7-fold). 2,4-dienoyl-CoA reductase mRNA (2.9-fold) and fatty acyl-CoA oxidase mRNA (1.7-fold). Compared to controls, the hepatic triglyceride biosynthesis was retarded as indicated by a decrease in liver triglyceride content (40%). The activities of glycerophosphate acyltransferase, acyl-CoA: 1,2-diacylglycerol acyltransferase and CTP:phosphocholine cytidylyltransferase were increased. The cholesterol lowering effect was accompanied by a reduction in HMG-CoA reductase activity (80%) and acyl-CoA:cholesterol acyltransferase activity (33%). In hepatocytes treated with methyl 3-thiaoctadeca-6,9,12,15-tetraenoate, fatty acid oxidation was increased 1.8-fold compared to controls. The results suggest that treatment with methyl 3-thiaoctadeca-6,9,12,15-tetraenoate reduces plasma triglycerides by a decrease in the availability of fatty acid substrate for triglyceride biosynthesis via enhanced fatty acid oxidation, most likely attributed to the mitochondrial fatty acid oxidation. It is hypothesized that decreased phosphatidate phosphohydrolase activity may be an additive mechanism which contribute whereby 3-thia fatty acids reduce triglyceride formation in the liver. The cholesterol-lowering effect of the polyunsaturated 3-thia fatty acid ester may be due to changes in cholesterol/cholesterol ester synthesis as 60% of this acid was observed in the hepatic cholesterol ester fraction.     

Successful early separation of a premature xipho-omphalopagus conjoined twins: a case report

Premature xipho-omphalopagus conjoined twins were successfully separated at 7 days of age. The total body weight of the twins before separation was 3502 g. One twin had persistent patent ductus arteriosus and signs of cardiac failure at 4 days of age. This was managed with indomethacin. Thirty-six hours later the second twin became anuric, necessitating early emergency separation. The twins were joined from the lower sternum to the infraumbilical area. The liver was fused, but there was no major vascular connection. There were no other major anomalies. The babies stood the procedure well and were healthy at follow-up 8 months after separation.     

Discovering the moments of movement in filial therapy: A single case qualitative study.

This study examines the process of change in filial therapy, a type of play therapy, which engages parents as therapeutic agents in working with troubled children. Outcome studies have supported the efficacy of this approach in building parent-child relationships, reducing parenting stress, and reducing child behavior problems. The purpose of this qualitative study is to examine the process in order to understand how these changes occur. The researchers compare the viewpoints of the therapist, the parents, and an independent observer, noting the points in therapy which are deemed facilitative or inhibitive of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system

OBJECTIVE: To analyze the causes of therapeutic success and failure in the management of patients with high-risk gestational trophoblastic tumors (GTTs). STUDY DESIGN: Analysis of 272 consecutive high-risk patients treated at the trophoblastic disease center at the Charing Cross Hospital between 1979 and 1995. RESULTS: EMA (etoposide, methotrexate, actinomycin D)/CO (cyclophosphamide, vincristine) chemotherapy is our treatment of choice for patients with high-risk GTT. In 272 consecutive patients the cumulative five-year survival was 86.2% (95% confidence interval, 81.9-90.5%). No deaths occurred from GTT more than two years after the start of treatment. In patients whose disease became resistant to EMA/CO or relapsed after receiving EMA/CO, the majority (70%) could be salvaged with further chemotherapy (usually with the EP (etoposide, cisplatin)/EMA chemotherapy with or without surgery. Multivariate analysis identified the following adverse prognostic factors: presence of liver metastases (P < .0001), prolonged interval from antecedent pregnancy (P < .0001), presence of brain metastases (P = .0008) and term delivery of antecedent pregnancy (P = .045). Intensive chemotherapy for treating high-risk GTT carries a small risk of inducing second malignancies, and two patients developed acute myeloid leukemia, 2 cervical malignancy and 1 gastric adenocarcinoma after receiving EMA/CO chemotherapy. CONCLUSION: EMA/CO is an effective and well-tolerated regimen for high-risk GTT. Salvage chemotherapy with EP/EMA is effective in the majority of patients whose disease is resistant to EMA/CO and should be combined with surgery when the dominant site of resistant disease is known. Major adverse prognostic variables have been identified, and patients with combinations of these factors should be considered for innovative therapeutic approaches from the outset.     

New perspectives in the treatment of acute mania: a single case report

1. There is increasing evidence that standard treatment of mania with lithium or neuroleptics fails in many subtypes of mania, e.g. dysphoric mania or rapid cycling, and new strategies are needed. 2. This single case report reports on possibilities and pitfalls in alternative attempts to tackle a severe manic syndrome successfully. 3. In this patient, lamotrigine and valproate, the latter only in an i.v. formulation, led to a relief from mania. 4. It is concluded that the success of this treatment may be due to a common underlying mechanism of action of these drugs, most likely on the level of ion channel regulation, and that further experience with alternative formulations of standard treatments such as valproate i.v. should be collected.     

Neuman's framework and ventilator dependency: a pilot study

The purpose of this article is to illustrate how the Neuman systems model guided a pilot study with ventilator-dependent patients. Mechanical ventilation was the external stressor to which these subjects reacted. The interaction of Neuman's client system variables was investigated to see which variables most influenced the weaning process. The pilot served to link model concepts with research variables and to identify appropriate procedures and tools for data collection.     

Termination in the case of Gary: Overdue, not premature.

Using the recent report of T. F. Van Denburg and E. J. Van Denburg (see record 1993-06526-001) as a case in point, the author advocates that when a patient quits treatment it may be more useful to ask "What should I have done differently?" rather than wonder why the patient finally declined more of the same. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transmyocardial revascularization: a case study

We evaluated the anatomic distribution and pattern of skin involvement in 155 pediatric patients with Henoch-Sch?nlein purpura treated in our center over the last 20 years. Of these, 120 (77.4%) presented with cutaneous signs; only 10% of them had no leg involvement. Seven patients (4.5%) had edema of the hands, feet, or face. The mean age of this subgroup was 9.2+/-2.2 months, compared to 6.8+/-2.3 years for the entire group (p < 0.05). Skin biopsies were performed in 18 of these patients, including the 7 with edema, to confirm the clinical diagnosis. All biopsy specimens showed leukocytoclastic vasculitis, with IgA deposits in two and C3 deposits in one. It is important that clinicians keep in mind that an atypical presentation of Henoch-Sch?nlein purpura is not unusual.     

Generalization of the effects of exposure treatments for phobias: A single case study.

Investigated generalization effects of exposure treatment of phobias in a multiple-baseline design with a 20-yr-old female who presented with fear of death (FOD), fear of losing control of herself (FLC), and excessive vulnerability to criticism (VTC). As predicted, treatment of FOD led to some improvement in the FLC but not in the VTC. Treatment of the FOD was associated with a worsening of 1 part of the VTC; treatment of the VTC led to a partial relapse of the FOD and FLC. Findings are explained in terms of conditioned cue and associative network models of the mental representation of fears. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Angioimmunoblastic lymphadenopathy: a case study

The case of a 57-year-old man with lymphadenopathy fever, splenomegaly, and polyclonal gammopathy is described. The difficult clinical course, the short lived response to cytotoxic treatment, the frequent infections, the immunologic abnormality, and the histologic findings in lymph node biopsy and postmortem material justified our diagnosis of angioimmunoblastic lymphadenopathy with dysproteinemia, a new entity described recently.     

Hypoglycemic hemiplegia: a case study

We report on a 59 year old patient with repetitive shoulder trauma due to numerous grand mal convulsions and consequent severe osteoarthritis of the shoulder joint with formation of multiple loose bodies. We discuss the aetiology of the loose bodies as being different to those found in synovial chondromatosis, as well as the radiological, histological, clinical and therapeutical features of this entity.     

Transmyocardial revascularization: a case study

Transmyocardial revascularization (TMR) is an investigational cardiovascular surgical procedure for patients with severe advanced coronary artery disease refractory to conventional treatment. The following case study traces one particular patient undergoing TMR from preoperative evaluation through a 6-month follow-up visit based on TMR research protocol.     

Prosodic deviation in dysarthria: a case study

Traditionally, prosodic difficulties in dysarthria have been described in phonetic terms with little attention being paid to the phonological implications of these impairments. This cast study attempts to illustrate the need for a phonological level of analysis. The speech of a 30-year-old ataxic dysarthric is analysed using Crystal's framework and the patterns are discussed in terms of the effect of the phonetic difficulties on the speaker's ability to use his intonation system to mark meaning contrasts. The analysis reveals that this speaker has developed a personal subsystem where he retains some of the features of 'normal' speech and systematically exploits variables still under his control to compensate for other deficits. This study highlights both the value of considering phonological aspects in the analysis of disordered prosody and the need for careful assessment of the appropriacy of the compensatory strategies that have been developed.