Psychotherapy and bulimia nervosa: evaluation and long-term follow-up of two conflict-orientated treatment conditions

Analytic in-patient therapy (n = 32) and systemic out-patient therapy (n = 39) were applied to patients with bulimia nervosa, and the effects were evaluated 14, 26 and 38 months after the start of the treatments. Our assumptions about the general efficacy of both conflict-orientated techniques were confirmed: both therapies satisfactorily reduced the symptomatic behaviour, as well as secondary factors related to bulimia nervosa, in the long term. However, we could not identify differential effects of the two treatment regimes, which we had expected with regard to the very different therapeutic approaches. The similarities of outcome of both therapies predominate, with slightly better results in the case of the analytic in-patient treatment. The results are discussed with regard to the assumption that specific healing factors are involved in conflict-orientated treatments in addition to the "common factors' of psychotherapy.     

Incontinentia pigmenti: clinical and neuroradiologic features

Developmental brain malformations and destructive processes of unknown etiology were described in incontinentia pigmenti (IP). Two patients, a male and a female, with characteristic skin lesions and central nervous system (CNS) involvement are reported. Neuroradiological examinations revealed hypoplasia of corpus callosum, neuronal heterotopias, and periventricular white matter damage. No specific infectious, inflammatory, or metabolic abnormalities were identified. These neuroradiographic findings may suggest that an ischemic pathogenetic mechanism occurred prenatally. We speculate that the brain damage in IP may occur during CNS development and in successive stages. Magnetic resonance imaging appears more useful to detect white matter lesions and brain malformations in patients with IP.     

Topical diphencyprone for alopecia areata: evaluation of 48 cases after 30 months'' follow-up

A patient is presented with complaints of a hypermobile right ear due to agenesis of the superior and posterior auricularis muscles and a thin concha cartilage. Suturing the concha cartilage to the mastoid bone and temporal fascia gave sufficient support of the external ear without creating a gross difference in appearance of both ears.     

Supratentorial arachnoid cyst and associated subdural hematoma: neuroradiologic studies

CT and MR images of 8 patients with supratentorial arachnoid cyst complicated by subdural hematoma were studied and compared with those of 8 patients who developed nontraumatic subdural hematoma without arachnoid cyst. Of the 8 patients with supratentorial arachnoid cyst, CT and MR disclosed temporal bulging and/or thinning of the temporal squama in all 6 patients with middle fossa arachnoid cysts, and the thinning of the calvaria was evident in another patient with a convexity cyst. Calvarial thinning at the site corresponding to interhemispheric arachnoid cyst was clearly depicted on coronal MR images. In contrast, none of the 8 young patients with nontraumatic subdural hematoma without arachnoid cyst had abnormal calvaria. Temporal bulging and thinning of the overlying calvaria were identified as diagnostic CT and MR features of arachnoid cyst with complicating intracystic and subdural hemorrhage. Radiologists should be aware of this association and should evaluate the bony structure carefully.     

Pregnancy-associated thrombocytopenia revisited: assessment and follow-up of 50 cases

Thrombocytopenia detected during pregnancy addresses the issue of its mechanism and of the possible occurrence of neonatal thrombocytopenia. To further investigate these issues, 50 women referred to us because of thrombocytopenia detected during pregnancy (platelet count, <150 x 10(9)/L), were extensively studied, as well as their offspring. Among these thrombocytopenic women, we used the threshold of 70 x 10(9)/L to differentiate between mild and severe thrombocytopenia. Whatever the severity of thrombocytopenia, we found biological features of an autoimmune disorder in 48% of the women, and chronic thrombocytopenia in 55%. A familial thrombocytopenia was evidenced in 1 case. These 50 women gave birth to 63 neonates, among whom 24 were thrombocytopenic, either at birth or during the first week of life. Neonatal thrombocytopenia could only be predicted in multiparous women, on the basis of previous neonatal thrombocytopenia in older siblings, and/or when maternal platelet life span study, performed before pregnancy, had evidenced an autoimmune thrombocytopenia (AITP)-like profile. These results suggest that, in case of pregnancy-associated thrombocytopenia, familial and immunological studies, combined with postdelivery iterative platelet counts, should be performed to properly characterize the thrombocytopenia. Moreover, the platelet count of the neonate should be carefully assessed at birth and during the following days, a platelet life span study should be performed after delivery in the mother, because these two parameters are likely to bring valuable information regarding the forthcoming pregnancies and the risk of neonatal thrombocytopenia.     

Topographic disorientation: two cases

BACKGROUND: There are many theories, but the etiology of chronic fatigue syndrome (CFS) remains unknown. Diagnosticians have set guidelines to try to classify the condition, but its clinical definition is one of exclusion rather than defined by specific clinical testing. The primary goal of this investigation was to find a diagnostic key to define CFS. CFS patients and those diagnosed with the sympathetic hypersensitivity condition called fibromyalgia syndrome (FMS) exhibit identical brain single photon emission computerized tomography (SPECT) images. Therefore, this investigation was initiated to see if CFS patients also had denervation hypersensitivity of the sympathetic system. METHODS: A standardized supersensitivity test was performed using an ocular instillation of two drops of 1.0% phenylephrine. Sixty-two subjects (29 CFS patients and 33 normals) participated in the study. Measurements of pupil size were recorded by pupil gauge and flash photography. A pupillary dilation of greater than 2.5 mm would suggest a sympathetic denervation hypersensitivity. RESULTS: For all participants, a small, but statistically significant increase in pupil size was found (mean of 0.788 mm in normals and 0.931 mm in CFS patients). The change in pupil size in the CFS patients and controls showed substantial overlap and was not statistically significant (t = 0.83, p = 0.42, dF = 60). CONCLUSION: In conclusion, the results suggest that a denervation hypersensitivity of the pupil does not occur in CFS patients. The use of 1.0% topical phenylephrine had no diagnostic value in detecting CSF patients vs. normals.     

Supratentorial ependymomas of the first two decades of life. Long-term follow-up of 20 cases (including two subependymomas)

According to literature, siderophages are a characteristic histological finding in the lung of deceased drug addicts (IVDA). It was the aim of our study to evaluate their pathognomonic significance. The lungs of 591 drug deaths in Hamburg were examined histologically for siderophages in two series, with different 'Berlinerblau' (Prussian blue) staining methods. The first series (investigation period 1980-1990) showed iron-containing macrophages in 36 of 420 drug deaths (8.6%) compared with a control-group (healthy young persons dying from unnatural causes of death) in which only one was positive (2%). In a second series, using a more sensitive staining method, 80 of 171 drug deaths (47%) in the year 1991 showed siderophages, whilst in a control-group, 17 of 35 cases (49%) were positive. According to our findings the pathognomonic value of siderophages in the lung of IVDA is doubtful. There is a need for further histochemical and ultrastructural investigations concerning the morphology and etiology of pulmonary macrophages in IVDA.     

Cervical adenitis: report of two cases

OBJECTIVES: A recent review or meta-analysis of epidemiologic studies concluded that persons with asbestos-related pleural plaques do not have an increased risk of lung cancer in the absence of parenchymal asbestosis. The reviewer inferred that this conclusion provided indirect supportive evidence for the proposition that asbestosis is a necessary precursor of asbestos-related lung cancer. The objective of the present communication is to contest these claims. METHODS: Finnish epidemiologic data and population statistics were used to estimate the apparent risk ratio of lung cancer associated with radiographic signs of pleural plaques. Power calculations were applied to compute the needed population sizes to demonstrate that the association is statistically significant. RESULTS: Unrealistically large population studies would be needed to observe the statistical relation between pleural plaques and lung cancer, quantitated as a risk ratio of 1.1, resulting from relatively low levels of environmental asbestos exposure. In realistic and valid epidemiologic studies on heavily exposed subpopulations, a two- or threefold risk can be identified. CONCLUSIONS: Uninformative studies should not be interpreted as providing suppressive evidence that pleural plaques are a noncausal risk indicator of lung cancer. Even for the null hypothesis, the inference that asbestosis is a necessary causal link between asbestos and lung cancer is illogical.     

Fiberglass dermatitis: report of two cases

Fiberglass is widely used for insulation and as a reinforcement filling material. Handling fiberglass products may induce contact dermatitis. We report on the first two cases of fiberglass dermatitis reported in Taiwan. The first patient suffered from a severe pruritic eruption two hours after repairing a roof with wave-form ceiling boards. Erythematous maculopapules were present on both hands and finger webs. The second patient was a quality controller of printed circuit boards (PRCBs). She presented with erythematous maculopapules on the face and excoriated papules and lichenified plaques on the trunk and forearms, which had been present for two years. Scrapings of the skin lesions from both patients showed fiberglass spicules of 7.5 to 8 microns in diameter. Similar fibers were detected in scrapings from the wave-form ceiling board and PRCB. Histopathology of the second case revealed spongiotic psoriasiform dermatitis. Patch tests in case 2 with the plastics and glues series, epoxy resin and scrapings from the PRCBs were all negative. Fiberglass dermatitis may be easily misdiagnosed. Clinically, it may resemble scabies, eczematous dermatitis, folliculitis, petechiae and urticaria. A high index of suspicion is essential for a correct diagnosis.     

Ameloblastic fibro-odontoma: report of two cases

Ameloblastic fibro-odontoma is a rare odontogenic tumour. It affects young people and is usually located in the posterior jaws. Two cases of this tumour are presented: both lesions had produced an asymptomatic swelling. The histology showed the presence of an odontogenic epithelium immersed in a fibrous mesenchyme; dental hard tissues were also present. No recurrences were found after 12 and 4 years from the surgical enucleation of the tumour.     

Cutaneous panniculitis and relapsing polychondritis: two cases

We report 2 uncommon cases of skin panniculitis (Pa) occurring during the course of relapsing polychondritis (RP). Skin histological findings were characterized by septal and lobular involvement associated with vasculitis. Chondritis and Pa lesions both regressed with steroid therapy and showed parallel clinical courses. To our knowledge, this type of cutaneous involvement has never been reported in RP.     

Marginal adaption of two esthetic complete crowns

In an in-vitro study twenty artificial crowns were fabricated. A hardened stainless steel five piece die assembly was used to construct uniformed wax patterns and to record all measurements. The fit of ten PFM crowns before and after the application of porcelain using the porcelain but margin technique was compared to that of ten Dicor crowns. The results of this study indicated best fit with the metal crowns before the application of porcelain, while the PFM crowns were oversized and the Dicor crowns were undersized.     

Wernicke's encephalopathy and dialysis: report of two cases

Wernicke encephalopathy is considered a complication of dialytic therapy, but there are few reports of this complication. We report a 57 years old man and a 45 years old woman, with grade IV renal failure, who after acute peritoneodialysis and chronic hemodialysis respectively, had a confusional syndrome that responded to the administration of thiamine. CT scans in both patients discarded abnormal blood collections or new cerebrovascular episodes. The man bad two previous cerebrovascular episodes, a severe anemia that was corrected, angina and an episode of arrhythmia during the dialytic procedure previous to the confusional episode. The woman had an acute uremic syndrome and a concomitant urinary tract infection during the confusional episode. Wernicke encephalopathy must be suspected in patients in dialysis with confusional episodes.     

Guepar hinge prosthesis: complications and results with two years' follow-up

Experience with the GUEPAR prosthesis in 292 cases of which 103 have been followed for more than 2 years, suggests that: implanting a hinge prosthesis is major surgery on elderly patients in whom severe complications have occurred and for this reason, the operations should be reserved for extremely damaged and unstable knees; the most important local complications have been deep sepsis for which we have noted a rate of 6.6 per cent; in the treatment of sepsis, everything must be done to preserve the prosthesis because arthrodesis is difficult to obtain; pain relief has been significant as a result of the operation. The prosthetic design allows flexion of more than 90 degrees in 85 per cent of the cases and 120 degrees in 26 per cent; after two years, the results seem relatively stable. We have not observed aseptic loosening after this period but a longer observation period is necessary to be reassured on this point; patellar pain remains a major concern because this arthroplasty has not solved the problem, and other solutions will have to be found.     

Pyoderma gangrenosum: a report of 44 cases with follow-up

Results of a study of 44 patients with pyoderma gangrenosum (PG) are presented. Each patient was diagnosed using standardized diagnostic criteria and followed up systematically. Thirty patients were women and 14 men. Their mean age was 50 years (range 11-80). Twenty patients had idiopathic and 14 parainflammatory occurrences (e.g. ulcerative colitis, Crohn's disease), whereas in 10 patients an associated haemoproliferative disease or neoplasia was noted. Whereas idiopathic and parainflammatory PG was found predominantly in women, the association with haemoproliferative diseases occurred more often in men. The lower legs and feet represented the typical predilection sites. Fifty-two per cent of patients had one lesion, 37% had up to five, and 11% had more than five lesions. Histologically, lymphocytic and/or leucocytoclastic vasculitis was present in 73% of the biopsy specimens obtained from the borders of the lesions. Long-term follow-up (n = 42, median follow-up 26.5 months) revealed that eight patients had died, in six cases due to the PG and/or the underlying diseases. Of the remaining 34 patients, 44% are in complete remission without further treatment, whereas continuing therapy is needed in 56%. No difference between idiopathic and parainflammatory PG was demonstrable in the follow-up and in no patient with idiopathic PG was a possibly related disease diagnosed in the follow-up. These data suggest that PG should be considered to be an independent disease and not a purely cutaneous complication in most patients.     

Pulmonary lipomatosis: a variant of placental transmogrification

An unusual pulmonary lesion is presented. The patient is a 55-year-old white man with a 2-week history of pleuritic chest pain, shortness of breath, and bronchopneumonia. The patient had also a history of smoking and chronic cough for 12 years. Chest radiographic studies showed a 20-cm bulla in the left upper lobe. A left upper lobectomy was performed obtaining an almost completely collapsed lobe with destruction of the normal architecture by a meshwork of yellowish tissue. Histologically, there were strikingly papillary structures composed almost exclusively of mature adipose tissue with small collections of inflammatory cells. Minimal emphysema in the adjacent lung parenchyma was observed. The case herein presented most likely represents part of the spectrum of placental transmogrification or placentoid bullous lesions of the lung.     

Chordoma: radiologic evaluation of 20 cases

Experience with 20 cases of chordoma is summarized. Three of four intracranial tumors presented as sellar tumors. The clivus remained intact for 2, 3 1/2, and 4 years, respectively, in three patients despite extensive destructive lesions of the sellar region. Our data and those of others indicate that approximately half the patients with chordomas have erosion of the clivus at the time of initial medical evaluation. The other half mainly have sellar destructive lesions with or without associated clival erosion. Calcification occurs in 50%-70% of intracranial chordomas. A nasopharyngeal mass is present in one-third. Vertebral chordomas often involve two or more vertebrae, producing destructive lesions which often have a sclerotic rim. The intervertebral discs are commonly affected. A paraspinal soft tissue mass, half the time containing calcification, is often present. Sacral lesions are characterized by a midline destructive lesion, occasionally associated with expansion, with or without osteosclerosis. A firm, fixed, extrarectal, presacral mass which may contain calcification or fragments of bone is almost always present.