The uncertain future of clinical psychology.

Examines the forces operating to inhibit the growth of clinical psychology, including the location of clinical training in the graduate school, the incompatibilities between a science and a profession, and the inappropriateness of the psychiatric setting and medical model. Consideration of the cost of viable alternatives includes 4 possible courses: (a) perpetuation of the Boulder model, (b) development of separate professional schools of psychology, (c) effecting a new liaison with another major profession, and (d) abandonment of clinical psychology as a separate field. Because of the difficulties in financing professional training, and the impending increased demand for teachers of psychology, it is concluded that clinical psychology, as it has developed, may decline in strength and importance for the next few years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emergence of peritoneal dialysis

124 patients with diabetes mellitus were examined in hospital of endocrine profile. The borderline mental disorders were revealed in 115 cases (92,7%) in the form of neurosis-like disturbances and pathological development of personality. Asthenic, asthenohypochondriac, asthenodepressive, obsessive and hysteroformic syndromes were diagnosed in patients with neurosis-like disorders. The personal disorders included asthenic, hysteric, obsessive, explosive and psychosomatic variations of development of the personality. Besides, poor cooperation of patients with the doctor was observed in the course of "diabetic control".     

The role of uncertain self-esteem in self-handicapping.

Evaluated the hypothesis posited by E. E. Jones and S. Berglas (see record 1980-25668-001) that some individuals confronted with an intellectual evaluation use a lack of preparation as a self-handicapping strategy. Sex and both level and certainty of self-esteem were examined with regard to the self-handicapping strategy of lack of effort. 54 female and 54 male undergraduates were divided into certain and uncertain and low and high self-esteem groups based on their scores on a self-esteem/certainty index. Ss were led to believe that the experiment was designed to update local norms for a nonverbal test of intellectual ability. After Ss' level of state anxiety was assessed with the State-Trait Anxiety Inventory, they were instructed in the benefits of practicing for the evaluation. Subsequently, Ss' state anxiety and preparatory efforts (the primary dependent variables) were measured. Ss' practice, self-protective attributions, and related affect supported a self-handicapping interpretation for uncertain males but not for uncertain females. Uncertain males practiced less than certain males and uncertain females, suggesting that the uncertain males may have been attempting to sever the ability–performance link on the upcoming evaluation following failure and/or to augment ability attributions if they had had a successful test experience. Where self-handicapping is concerned, it may not be how much sense of personal worth an individual has but how firmly the individual senses that personal worth is the key. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The problem with problem solving

PURPOSE: We conducted a prospective study of patients with primary pterygia to analyze surgically-induced astigmatic changes following pterygium surgery and their relation to pterygium morphology and size. METHODS: One hundred twenty-three eyes of 123 adult patients with primary pterygia were evaluated. Pterygium was graded according to morphology and the extent of corneal encroachment. Manifest refraction was performed preoperatively and at 1, 3, and 6 months postoperatively. Patients underwent either the bare sclera technique of pterygium excision or conjunctival grafting. Surgery was performed by one surgeon. Olsen's method of vector decomposition was used to analyze surgically-induced astigmatism. RESULTS: The mean magnitude of preoperative astigmatism was 0.99 D, with vector decomposition revealing a relative flattening of the cornea in the horizontal meridian. Astigmatism of 1.00 D or more was seen when the pterygium exceeded 3.5 mm beyond the limbus. Postoperatively, a steepening of the cornea in the horizontal meridian was demonstrated, the magnitude of which was related to pterygium size (P = 0.0001). ANOVA testing showed no significant difference (P > 0.05) when pterygia were divided according to morphology. CONCLUSIONS: This study confirms that pterygium excision induces a reversal of pterygium-related corneal flattening. A strong correlation was also found between the horizontal extent of pterygium encroachment and astigmatic change following surgery.     

The Chichester diagnostic peritoneal lavage simulator

In developing countries without access to laboratory testing, the syndromic management of cervicitis in women with lower genital tract symptoms results in overtreatment. We evaluated the validity of using different age cut-offs to predict the risk of cervical infection in women attending a clinic for sexually transmitted diseases in Cape Town. Specimens from 161 women with lower genital tract symptoms were examined microbiologically for evidence of cervicitis (gonorrhoea and/or chlamydial infection). Women with cervicitis (median 21 years) were significantly younger than those not infected (median 23 years). Retrospective simulation using the age cut-offs (< 45 years (current approach), < 30 years, and < 25 years) to predict cervicitis showed that specificity could be increased (overtreatment reduced) from 17% to 50% if presumptive diagnoses of cervicitis were restricted to women aged under 25 years. Lowering the age cut-off would severely limit sensitivity, however, and as many as 9% and 20%, respectively, of infected women would go untreated if the age cut-offs < 30 and < 25 years were used. The use of a lower age cut-off would therefore serve neither individual nor public health in the presumptive diagnosis and treatment of cervicitis in a high risk population, and would result in a substantially lower detection rate.     

The role of neutrophils in peritoneal adhesion formation

The most common cause of intraperitoneal adhesions is previous abdominal surgery. Postoperative adhesion formation results from a fibroproliferative inflammatory reaction that begins with an influx of polymorphonuclear leukocytes (PMNs) into the peritoneal cavity. Adherence of the PMNs to the endothelial cells (EC) is necessary for PMN migration into the tissue in response to a stimulus. Several receptor-counterreceptor pairs of ligands such as CD11/CD18 on the PMN and ICAM-1 (CD54) on EC have been identified. Monoclonal antibody against CD11/CD18 (R15.7) inhibits PMN adherence and migration and consequently protects against PMN-induced tissue injuries. We therefore studied the effect of preventing PMN-EC adherence, using anti-CD18 monoclonal antibody, on postoperative adhesion formation in rabbits. Group 1 was a control receiving physiologic saline, and group 2 received anti-CD18 antibody (R15.7, 2 mg/kg). The treatment was administered iv at the end of surgery and repeated on the first and second postoperative days. Peritoneal adhesions were induced at laparotomy by repairing two peritoneal defects, by oversewing the defect (model 1), and by resuturing the removed parietal peritoneum in its place as an ischemic graft (model 2). Adhesions were evaluated blindly at 10 days after operation by measuring the percentage of the suture line covered with adhesions (model 1) or by a scoring system (model 2). All control animals developed intraperitoneal adhesions and the percentage of the suture line covered with adhesions was 25 +/- 5.9% (mean +/- SEM) and the mean score in model 2 was 0.9 +/- 0.2. Anti-CD18 antibody, R15.7, increased the degree of postoperative adhesion formation in both models, but the results were significant only in model 2. Also, anti-CD18 antibody significantly decreased peritoneal neutrophils from 11.1 x 10(7) +/- 1.8 x 10(7) to 2.2 x 10(7) +/- 0.4 x 10(7) (P < 0.001) on the first postoperative day. It is concluded that inhibition of PMN-EC adherence does influence the postoperative adhesion formation. These results might suggest that PMNs have a role in modulating postoperative adhesion formation.     

"The uncertain future of clinical psychology": Erratum.

Presents an error in the original article by G. W. Albee (American Psychologist, 1970 [Dec], Vol 25[12], 1071–2080; see record 1971-08263-001). The following incorrect statement appears on page 1077, lines 15–27: "…the American Medical Association has relinquished its tax-exempt status in order to participate actively in attempts at influencing legislation…' The American Medical Association has never relinquished its Sec. 501(c) (6) tax-exempt status and continues in this category to this date. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The problem of asbestos today

In the past 2 years, a 4 year-old boy has had an anaphylactic reaction whenever he contacted food prepared with fish. The symptoms included intense itching in the throat and eyes, which progressed to generalized urticaria and facial angioedema. This was accompanied by cough, wheezing and dyspnea. Many fish preparations caused these episodes including several different kinds of fish (cod, tuna, salmon, trout, eel...), fish soup, chopsticks contaminated with fish preparations and canned fish. Elevated levels of total serum IgE (224 IU/ml) and specific IgE for cod (93.1 IU/ml), tuna (> 100 IU/ml), salmon (> 100 IU/ml), trout (64.4 IU/ml), mackerel (41.2 IU/ml) and eel (28.1 IU/ml) were found by the Pharmacia CAP system RAST FEIA in our allergy clinic. A skin prick test for mixed fish extracts (contain flounder, cod and halibut) was positive. A fish challenge test for cod, tuna, salmon, trout and eel all showed anaphylactic reactions. His allergic symptoms stabilized gradually after strictly avoiding ingestion of fish and using drug treatment. He also had a similar anaphylactic reaction to frogs. The best treatment for fish allergy is avoidance. Avoidance of fish may need to include both ingestion and inhalation of cooking vapors.     

Pathophysiology of peritoneal fluid eosinophilia in peritoneal dialysis patients

This study deals with the stress distribution in concrete deck slabs on composite steel beams used with integral abutment bridges. The applied loading is composed of one or more side-by-side HS20-44 trucks. The finite-element method is used to analyze two bridge structures with different numbers of beams, beam spacings, and supporting piles. The transverse and longitudinal slab stresses in the deck slab are investigated in the positive and negative bending regions near and away from the integral abutment. The slab stresses in the integral abutment bridges are compared with the corresponding stresses induced in the slab of equivalent jointed bridges. The results indicate that integral abutment bridges distribute the loads in the deck slab more uniformly than their jointed counterparts. The maximum stresses in the transverse direction of the slab can be 25–50% lower in the integral bridges than in their corresponding simply supported ones.     

The peritoneal free flap: an anatomic study

In view of a possible clinical application of an isolated microvascular peritoneal flap, an anatomic study was performed in order to determine the peritoneal vascular territory of the deep inferior epigastric artery. For this, the deep inferior epigastric artery was injected unilaterally with Araldite in 30 embalmed cadavers and bilaterally with india ink in 15 fresh cadavers. In 70 percent of the embalmed cadavers, a constant pattern of three branches from the deep inferior epigastric artery could be identified. The peritoneal vascular supply is not derived solely from these three branches but also from multiple small branches sprouting directly from the main stem of the deep inferior epigastric artery and from segmental and muscular branches. Therefore, classification of peritoneal branches arising from the deep inferior epigastric artery seems to be of little clinical importance. In all cases, the india ink injected in the deep inferior epigastric artery colored a similar territory of the parietal peritoneum. Considering the magnitude of the peritoneal vascularization by the deep inferior epigastric artery, implementation of an isolated free or pedicled peritoneal flap seems to be possible. Such a microvascular peritoneal flap vascularized by the deep inferior epigastric artery may be used, for example, for reconstruction of mucosal defects in the head and neck region.     

Continuous hyperthermic peritoneal perfusion for peritoneal dissemination of gastric cancer

BACKGROUND/AIMS: We investigated the histological and clinical effectiveness of continuous hyperthermic peritoneal perfusion (CHPP) for treating peritoneal dissemination (therapeutic CHPP) and for the prevention of peritoneal recurrence (prophylactic CHPP). METHODOLOGY: In 5 patients with gastric cancer and peritoneal dissemination, the apoptosis index of the cancer cells on in situ end-labeling for detection of apoptotic cells was 3.0+/-1.2% before CHPP, and had increased to 52.9+/-8.3% after CHPP. The survival curve of the therapeutic CHPP group was significantly better than that of the control group. The therapeutic CHPP group was classified as miliary type or nodular type. The survival curve in the miliary type was significantly better than that in the nodular type. RESULTS: In prophylactic CHPP, there was no improvement in prognosis, but a prophylactic effect against peritoneal recurrence was demonstrated in the patients who were n4 negative when the mean intraperitoneal temperature during CHPP (MIT) was maintained above 42 degrees C. CONCLUSIONS: These results indicated that an improved prognosis can be expected after therapeutic CHPP in patients with peritoneal spread. The beneficial effects are especially marked in patients with the miliary type. Moreover, prophylactic CHPP exerts a prophylactic effect against peritoneal recurrence in patients with n4 negative, providing that the MIT can be maintained above 42 degrees C.