Care of the pediatric solid organ transplant recipient. The primary care perspective

Although transplantation is an effective therapy for many end-stage organ diseases, this treatment cannot be totally successful without continued careful medical management, monitoring, and psychosocial support. Transplantation is a lifelong commitment. Primary care physicians can lay the foundation for ongoing care by providing medical intervention when appropriate and maintaining close communication with the transplant center, but perhaps more importantly by developing a relationship with these children and their families that impacts adherence to care will promote an optimal quality of life.     

Sarcoidosis: a pediatric perspective

Childhood sarcoidosis is a rare multisystemic granulomatous disease of unknown etiology. The clinical presentation can vary greatly depending upon the organs involved. Two distinct forms of sarcoidosis exist in children. Older children usually present with a multisystem disease similar to the adult manifestation, with frequent hilar lymphadenopathy and pulmonary infiltration. Early-onset childhood sarcoidosis is a unique form of the disease characterized by the triad of rash, uveitis, and arthritis in patients presenting before age 4 years. The diagnosis of sarcoidosis is confirmed by demonstrating a typical noncaseating granuloma on a biopsy specimen. The current therapy of choice for childhood sarcoidosis with multisystem involvement is corticosteroids. Methotrexate given orally in low doses is effective and safe and has steroid-sparing properties.     

The pediatric psychologist: A role model.

Discusses the special knowledge, training, and roles required in the emerging subspecialty of pediatric psychology. Because psychologists in the pediatric setting will be working with a clientele consisting of nonpsychiatric referrals and colleagues not primarily interested in behavioral problems, they will need training in both normal child development and personality in clinical areas. Another area of concern is childrearing and the optimal climate for cognitive, affective, and interpersonal growth. In addition, requests for cognitive and/or developmental appraisals will be high, and there will be a need for more emphasis on applied vs basic research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The actinic keratosis. A perspective and update

BACKGROUND: Actinic keratosis (AK) is a common sun-induced precancerous neoplasm confined to the epidermis. It is the initial manifestation of a continuum of clinical and histologic abnormalities that progresses to invasive squamous cell carcinoma (SCC), a disorder that accounts for thousands of preventable deaths in America each year. OBJECTIVE: The purpose of this work is to describe the actinic keratosis. METHODS: This effort was performed by a literature review and analysis. RESULTS: Like SCCs, the vast majority of AKs are asymptomatic. Although some actinic keratoses may become clinically inapparent, possibly either due to immune rejection or simply having their external surface unknowingly scraped off, an untreated AK represents a potentially curable fatal cancer. CONCLUSIONS: Each AK should be treated before it progresses to invasive squamous cell carcinoma. Destructive modalities such as cryosurgery using liquid nitrogen and electrodesiccation and curettage are the mainstays of therapy. Each case must be individualized. LEARNING OBJECTIVES: After studying this article, participant should be able to: 1. Understand the concept of an actinic keratosis. 2. Learn how to recognize its clinical manifestations. 3. Be aware of the danger it poses as an easily curable papulonodule that may become a fatal cancer.     

The smoking problem: A behavioral perspective.

A review of behavioral work on cigarette smoking indicates that behavioral analysis of the determinants of smoking has lagged far behind pharmacological research and, partly as a result of cessation/maintenance strategies, still lacks adequate empirical and theoretical bases. Multicomponent programs that include aversion seem most effective. However, nicotine chewing gum has a theoretical base, shows promising results in clinical trials, and may be a useful adjunct to behavioral strategies. Much progress has been made in developing biochemical measures of smoking, of which saliva thiocyanate is the most useful. Preventive interventions with adolescents provide an opportunity for behavioral contributions to the etiology of smoking. (109 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A realist perspective.

Discusses whether changes in theoretical positions in psychology represent genuine progress or merely current opinion and proposes that psychology's problems are epistemological rather than ethical. A realist position is espoused that is not in line with the dominant view in psychology of the relation between theorizing and data and of the proper way to settle scientific disputes. An instrumentalist position like that of constructionism is suggested to lead to lower levels of evidential sensitivity. Some unsound doctrines that are implicitly or explicitly adopted are explored. First, because certain truth is unattainable, truth should be abandoned as the primary criterion of theories. Secondly, there is no difference between theories and models. The third doctrine is that of dualism, which has recently emerged in arguments about the logic of treatment evaluation in psychology. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic frame revisited: A contemporary perspective.

Argues that since it was first proposed, the therapeutic "frame" has been widely adopted in a relatively unquestioned manner despite major modifications in clinical theory and practice. A reexamination of the frame from a contemporary perspective is presented. While traditional conceptions of the frame emphasize its function for the client, it is argued that this structure also serves a crucial purpose for the therapist. By minimizing the opportunity for self-indulgence (e.g., by fostering abstinence, anonymity, and neutrality), the frame enables the clinician to maintain a therapeutic stance and to create an environment that fosters comprehension of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The pathos of power: A psychological perspective.

Discusses the ability of psychotechnology to control the fragility and pathos of the ego, which can create and validate humanity while also rationalizing cruelties and inhumanity. The negative, animalistic characteristics of man must be subordinated to the positive values of love and empathy without sacrificing creativity or selective capacities. It is proposed that a program of direct biochemical intervention be implemented to control negativistic tendencies, with compulsive criminals as pretest Ss. Ultimately, world leaders who have the nuclear power to determine the fate of humanity should be given the earliest perfected form of appropriate drugs. This requirement would control the barbaric use of power and insure that survival of the human species is not sacrificed to the personal ego pathos of powerful individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A perspective on disgust.

Approaches disgust as a food-related emotion and defines it as revulsion at the prospect of oral incorporation of offensive objects. These objects have contamination properties; if they contact an otherwise acceptable food, they tend to render it inedible. Issues considered include: the nature of the objects of disgust and why they are virtually all of animal origin, the meaning of oral incorporation, the belief that people take on the properties of the foods they eat, the nature of the contamination response and its relation to the laws of sympathetic magic (similarity and contagion), and the ontogeny of disgust, which is believed to develop during the 1st 8 yrs of life. The idea that feces, the universal disgust object, is also the 1st is explored, and the mechanisms for the acquisition of disgust are examined. Disgust is recommended as an easily studiable emotion, a model for cognitive–affective linkages, and a model for the acquisition of values and culture. (103 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A perspective on thinking.

Research on general thinking abilities—productive, higher order, critical, and creative thinking—has progressed slowly compared with the rapid progress that has been made in the study of cognitive structures and procedures. As alternatives to currently prevailing assumptions, three framing assumptions for the study of thinking are proposed, involving situated cognition, personal and social epistemologies, and conceptual competence. Evidence consistent with these assumptions is outlined, and topics in the psychology of thinking are discussed in relation to the assumptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The pediatric airway. 1962

Stroke is the third leading cause of death in the United States. Carotid artery stenting is being investigated as a therapeutic strategy for the management of extracranial bifurcation stenosis and has the potential to prevent stroke in thousands of patients. Carotid endarterectomy, although effective, does have limitations, and percutaneous techniques may offer an alternative method of treatment, especially for those who are at highest risk. Although the technique is still evolving, this article describes the protocol and technique of stent-supported carotid angioplasty and care for patients undergoing this procedure at Washington Adventist Hospital in Takoma Park, MD.     

Psychiatric perspective of pediatric human immunodeficiency virus infection

BACKGROUND: Infection due to human immunodeficiency virus (HIV) has become a chronic disease of childhood, with increasing rates among adolescents and longer survival of those infected. This illness and its victims present a continuing challenge to the medical community. METHODS: We used computerized literature searches (MEDLINE and AIDSline) to identify research and review papers from medical, psychiatric, and psychology journals; we obtained statistics directly from the Centers for Disease Control and Prevention, National AIDS Clearinghouse. RESULTS: This overview of the topic includes epidemiology, transmission, diagnosis, psychiatric and neuropsychiatric manifestations, intervention, and the impact on families, caretakers, and health care workers. CONCLUSIONS: To psychiatrists, this disease presents the epitome of the biopsychosocial model, encompassing the biology of a viral disease with psychiatric manifestations, complicated by the societal place in which it has become entrenched.     

The Bender Gestalt: A review and a perspective.

The 1950-61 literature is covered and is organized around the test designs, the various scoring systems, and the diagnostic interpretations. When scored objectively its validity in determining mental ages for children, and as an additional tool in a test battery aimed at differential diagnoses, is acceptable. Symbolic interpretation remains highly subjective. The lack of standardization mitigates against utilizing the test as a norm against which to judge other variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A three-person perspective on transference.

Different approaches to psychoanalysis may be classed according to the number of persons that they assume to be necessary in order to adequately describe mental life. One-person approaches assume the basic autonomy of the individual to act as a subject in her world, while 2-person approaches assume the irreducibility of object and subject, their essential complementarity and their mutual affirmation as subjects. Three-person approaches, on which the present article focuses, argue that the subject can fully develop only by creating enough space for herself among other persons who compete for subject positions. Such space is created in relation to (at least) 2 other subjects, hence the system of 3 persons. In the 3-person perspective, the position of the subject is defined as First, and the Second is defined by the one with whom the subject identifies and in whom she mirrors herself through cycles of projection and introjection. The position of the Third involves the personification of the cultural matrix and, especially, the way language informs our ability to relate to each other. This is best represented in the universal system of personal pronouns: the subject takes the position of the 1st person (I), the Second takes the position of the 2nd person (You), and the Third is posited as the 3rd person (she or he and it). In psychoanalytic therapy, the patient takes the position of the Subject, the First. Transference is construed as the superposition of both the 2nd and the 3rd persons upon the figure of the analyst, a mental process that (re)creates the necessary conditions for the development of subjecthood. As a result, in the discourse of transference, the position of the analyst keeps fluctuating between the 2nd and 3rd positions: When one takes place on the actual level, the other acts in the background, and vice versa. The therapeutic consequences of this view are discussed; for example, transference love is construed as a process in which the 2nd person struggles to dominate the positioning of the analyst. Other transferential configurations are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cognitive-behavioral perspective on termination.

The issue of termination as viewed from a cognitive-behavioral orientation is considered within the context of the duration of treatment, the goals of therapy, and the underlying coping skills model that characterizes this orientation. These factors make a cognitive-behavioral approach to therapy both similar to and different from other orientations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biological warfare. A historical perspective

Several modifications of the 3H-tetracycline bone labeling method for measuring whole skeleton bone resorption were tested. Under steady state conditions of whole skeleton resorptive activity, bone labeling for intervals longer than 2 weeks prior to experimentation did not significantly alter the urinary 3H-tetracycline loss curve. The utilization of nonlinear regression analysis showed that the urinary loss of 3H-tetracycline was best described by double exponential equations, indicating the loss of label from two distinct and independent exchangeable bone compartments. This conclusion was supported by the finding that soft tissues were effectively depleted of 3H-tetracycline by 24 hours after the final injection of label. Hence, it was concluded that approximately 40% of the 3H-tetracycline loss from skeletal bone is associated with a "fast" compartment which is depleted within 6 or 7 days after label loading. The size and rate of 3H-tetracycline loss from the fast compartment decreased (40%) with age such that the depletion time remained constant between 8 and 24 weeks of age in both male and female rats. The remaining 60% of 3H-tetracycline loss from a "slow" compartment which was depleted in about 70 days in young (8 week) rats. This compartment, which is believed to reflect cell-mediated resorption of calcified bone; decreased in size with age in both male (50%) and female (30%) rats. The rate of label loss from this compartment, however, remained relatively high so that the depletion time decreased (approximately 35%) between 8 and 24 weeks of age. By determining whole skeletal mass and calculating these parameters on the basis of skeletal mass, we were further able to demonstrate significantly higher resorptive activity in female than in male rats by 24 weeks of age.