Aspiration cytology of tubular adenomas of the breast. An analysis of eight cases

History-taking from women with pelvic floor problems becomes easier with practice. In the time it has taken you to read this chapter, the histories of several patients could have been ascertained. Efficiency during the focused history will assume increasing importance as time constraints tighten. Combined use of written and verbal assessments provides maximum information in a concise fashion. This technique allows the treating physician to educate the patient while being sensitive to her individual concerns, such as her specific preferences for treatment and her social/lifestyle considerations. Efficient medical and/or surgical recommendations can be given within this context. These recommendations can reflect the preferred treatment given the milieu of the entire pelvic floor anatomy and function after physical examination and any appropriate testing.     

An innovative technique of video replay for reempowering an incest survivor and protecting the integrity of the family.

Reports on the combined individual and family therapy of a 17-yr-old survivor of incest following the incarceration of her father and her removal from home. After 1 yr of individual therapy, family therapy was initiated including the perpetrator-father who was released from jail for the sessions. The aims of therapy included protecting the integrity of the family and reinstating the victim's position in the family if possible. Therapeutic tools which were most relevant in promoting these changes are detailed with specific emphasis on an innovative use of video which served both to protect the youngster, reempower her, and reengage the family with her. The dilemma of voluntary vs legally mandated therapy in the management of resistance is closely examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benign paroxysmal tonic upward gaze syndrome

INTRODUCTION: The benign paroxysmal tonic upward gaze syndrome (BPTUG) is a rare condition. We present two new cases analyzing the clinical, genetic, evolution and therapeutic aspects. CLINICAL CASES: Case 1. A 2 year-old girl with no family history of similar disorders started, at the age of 6 months, to have episodes of upward deviation of gaze with hyperextension of the neck and vertical nystagmus of fixation, increased by nervousness and episodes of fever. Some episodes caused the patient to fall in spite of there being no alteration of consciousness. Case 2. From the age of five months a 1 year-old girl with no significant personal or family history had episodes of ocular deviation upwards with forward inclination of the head to correct her gaze and slow motor development from the age of five months. RESULTS: Complementary studies were normal in both patients. As in the cases described in the literature, our cases had no family history and were not sensitive to Dopa. To date 11 children have been described in the literature and few familial cases seen with dominant autosomal inheritance. CONCLUSIONS: Our patients had a non-epileptic paroxystic phenomenon known as BPTUG syndrome. This condition starts during the first year of life, has a benign course and the episodes have ceased by the age of four years. We believe it is important to consider the differential diagnosis with epileptic phenomena, evaluate the response to L-Dopa and bear in mind that this syndrome may be the clinical expression of several different conditions. Although the course is usually benign, it may later be associated with other signs of neurological problems which should be taken into account.     

Gypsum-bonded alumina dental investment for high-fusing casting

During the last 20 years family therapy has well been established as a supplementary or alternative therapy to individual therapy within child and adolescent psychiatry. Along with the further development and the change of concepts of family therapy there has been a greater interest in the interrelationship within the triad of patient-family-therapist, too. In the training of family therapists the meaning of the family of origin has been recognized. The implications of the therapeutic professional activities on the psychiatrist's family has not yet thoroughly considered, however. In the present paper the development and the characteristics of some main concepts of family therapy are described. Illustrated by a case report the influences of family oriented therapeutic activities over the therapist's family are presented. Finally the interrelationship between the patient's and the therapist's family are discussed as a constructive element of a mutual learning process.     

The devalued (unloved, repugnant) self: A second facet of narcissistic vulnerability in the aggressive, conduct-disordered child.

Suggests that whereas the disregarded self reflects the child's fear that others do not care about him/her, the devalued self reflects the belief that there is something grossly repugnant about the child that makes people reject and abandon him/her in disgust. Much of the conduct-disordered child's antisocial behavior and character stance can be understood as an attempt to cope with and defend against these feelings of being unloved and unlovable. Manifestations of, and defenses against, the devalued self are discussed, primarily in terms of how they can be observed during the course of intensive treatment. Implications of the concept for individual psychotherapy and milieu treatment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reproductive characteristics of a population of urban Swiss women

OBJECTIVE: To describe the variability of reproductive life, from menarche to menopause, in the Geneva female population. DESIGN: Women's Health Survey, 1992-1993. SETTING: Mobile epidemiology unit of a University Hospital. SUBJECTS: One thousand and thirty-two women aged 30 to 74 years, resident in Geneva, Switzerland. MAIN OUTCOME MEASURE: Menstrual and reproductive history. RESULTS: A 'typical' woman of Geneva has her menarche at 13 years, regular 28 day cycles with 5 days of menstrual flow. She is 26 years old when she first gives birth and has her last baby (which is typically the second) at age 31. She has 37 years of potential fecundity and a natural menopause at age 50. In addition, 11% of the women have tried to be pregnant during two years without success, 67% have ever used oral contraceptives, 20% had a first birth at age 30 or more and 23% were nulliparous. Younger women reported earlier ages at menarche. Women with lower education tended to be a younger age at the birth of her first child. CONCLUSIONS: In this first study of the reproductive characteristics of women in Geneva, nulliparity and a late first birth appeared unusually frequent, especially when compared with American or Chinese women. The observed distributions of reproductive history are compatible with the very high incidence rate of breast cancer in the Geneva population.     

Accelerated metabolism of ethanol in patients with burn injury

We report on a Japanese girl with Turner syndrome (45,XO) who developed ganglioneuroma of the left adrenal gland during growth hormone (GH) therapy. She had received GH replacement therapy from the age of 6.8 years. At the age of 10.3 years, abdominal ultrasonography revealed a mass which occupied the upper area of her left kidney. Computed tomography and magnetic resonance imaging of the abdomen showed a low density mass with a smooth surface located between the upper portion of the left renal vein and the pancreas. Microscopic examination resulted in a diagnosis of ganglioneuroma of the left adrenal gland. At present we cannot conclude that patients who have received GH replacement therapy are at higher risk for developing tumors compared to those without GH replacement therapy.     

Pathways to Violence in the Children of Mothers Who Were Depressed Postpartum.

The impact of postnatal depression on a child's risk for violent behavior was evaluated in an urban British community sample (N=122 families). Mothers were interviewed during pregnancy, at 3 months postpartum, and when the child was 1, 4, and 11 years of age. Mothers, teachers, and children reported on violent symptoms at age 11. Structural equation modeling revealed that the child's violence was predicted by the mother's postnatal depression even when her depression during pregnancy, her later history of depression, and family characteristics were taken into account. Violence was associated with symptoms of attention-deficit/hyperactivity disorder and problems with anger management. Children were most violent if mothers had been depressed at 3 months and at least once thereafter. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Polysubstance abuse--a case study

This article presents the case history of a 23-year-old white male's recovery from 12 years of alcohol and other substance abuse. The peer pressures that led to the experimental use of marijuana at age 11 and the evolving social relations that contributed to chronic substance use are described. Included are details about the subject's family life, peer relationships, criminal involvement, and transition from alcohol and marijuana use to chronic amphetamine addiction. Experiences with drug burn-out and the eventual rehabilitation and recovery process that led to a lifestyle that is currently free of drugs. The case is discussed in the context of current theoretical and empirical research in adolescent drug abuse.     

Spinocerebellar ataxia type 6. Molecular and clinical features of 35 Japanese patients including one homozygous for the CAG repeat expansion

Spinocerebellar ataxia type 6 (SCA6) is a newly classified autosomal-dominant cerebellar ataxia (ADCA) associated with CAG repeat expansion. We screened 111 patients with cerebellar ataxia for the SCA6 mutation. Of these, 35 patients were found to have expanded CAG repeats in the SCA6 gene, indicating that second to SCA3, SCA6 is the most common ADCA in Japan. Expanded alleles ranged from 21 to 29 repeats, whereas normal alleles had seven to 17 repeats. There was no change in the CAG repeat length during meiosis. The age at onset was inversely correlated with the repeat length. The main clinical feature of the 35 patients with SCA6 was slowly progressive cerebellar ataxia; multisystem involvement was not common. The 35 patients included nine cases without apparent family history of cerebellar ataxia. The sporadic cases had smaller CAG repeats (21 or 22 repeats) and a later age at onset (64.9 +/- 4.9 years) than the other cases with established family history. We also identified one patient who was homozygous for the SCA6 repeat expansion. The homozygote showed an earlier age of onset and more severe clinical manifestations than her sister, a heterozygote carrying an expanded allele with the same repeat length as the homozygote. This finding suggests that the dosage of the CAG repeat expansion plays an important role in phenotypic expression in SCA6.     

Tachykinin NK2 receptors: characterization in the rat small intestine by the use of a peptide agonist and a nonpeptide antagonist as radioligands

OBJECTIVE: A rare family pedigree is described with a multigenerational history of an early onset, non-Alzheimer's dementia consistent with autosomal dominant inheritance. Information on five generations, with 26 suspected or proven cases of dementia, are presented. METHOD: Previous work on the family was collated and verified. The pedigree was updated. Thirty-three family members agreed to be interviewed for the present study. Standardised clinical information was obtained using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) National Adult Reading Test (NART), vocabulary and digit substitution subscales of the Wechster adult intelligence scale-revised edition (WARS-R). Abbot samples were taken for biochemical and genetic analysis. RESULTS: Fifteen males and 11 females have been affected. The age of onset of dementia in those for whom data were available (n = 12) ranged from 39 to 64 years with a mean of 53 years. The duration of illness ranged from 4 to 14 years and the age at death ranged from 49 to 69 years (mean 62 years). Autopsy data exist for nine cases. In one case the neuropathology was consistent with Alzheimer's disease. In two cases the diagnosis of Pick's disease was made on the basis of frontal or frontal/temporal lobe atrophy without Pick bodies or cells. One case diagnosed as Pick's disease had frontal/temporal lobe atrophy with cells resembling Pick's bodies. In the five remaining cases there were no distinctive neuropathological features to differentiate the type of dementia. CONCLUSIONS: The importance of recognising familial dementia, collating information on multiple generations and prospectively collecting standardised data is discussed.     

An investigation of a family tree with congenital deficiency in coagulation factor XIII]

In order to study the hereditary trait of a 20-year-old girl with congenital deficiency of coagulation factor XIII and her family tree, the following laboratory tests were done for the propositus and her family members: clot solubility test in 5 mol/L urea, estimation of factor XIII activity, amount of the subunits A and S of factor XIII with rocket electrophoresis. The results showed that the propositus had clinical history of bleeding in umbilical cord and its stump after birth. Her parents are not consanguineously related and have no history suggestive of hemorrhagic diathesis. The propositus has one brother and three sisters. One of her sisters died of bleeding of the umbilical cord after birth, another died at age of two, but the reason of her death is unclear and the remaining siblings are clinically healthy. The propositus had an abnormal urea clot lysis test, but the other family members had normal results. For the propositus factor XIII activity was 0%. A subunit 0% and S subunit 8.2%. Factor XIII activity of her father, her mother and her sister were 25%, 50%, 25% respectively. A subunit 52%, 58%, and 58% respectively and S subunit 66%, 68% and 66% respectively. The results showed that the propositus has a congenital deficiency in coagulation factor XIII, and her parents and sister are in fact carriers.     

Obstetric complications and age at onset in schizophrenia: an international collaborative meta-analysis of individual patient data

OBJECTIVE: An excess of obstetric complications in the histories of schizophrenic patients is a well-replicated finding, but less consistent results have been found concerning the relationships between obstetric complications and family history of schizophrenia, age at onset of schizophrenia, and gender. Small sample size limited the power of previous studies that attempted to assess such relationships. The aim of this study was to use data on individual patients from all available studies to examine the links between a history of obstetric complications and family history of schizophrenia, age at onset, and gender. METHOD: Raw data from 854 schizophrenic patients concerning history of obstetric complications rated according to the Lewis and Murray scale were obtained from 11 different research groups. Weighted average estimates were calculated with the use of regression techniques. RESULTS: A significant association was found between age at onset of schizophrenia and obstetric complications: the earlier the age at onset, the more likely the history of obstetric complications. Subjects with onset of schizophrenia before age 22 were 2.7 times more likely than those with onset at a later age to have had a history of abnormal presentation at birth and 10 times more likely to have had a history of complicated Cesarean birth. No association was found between obstetric complications and family history of schizophrenia or gender. CONCLUSIONS: The association between obstetric complications and early age at onset of schizophrenia indicates that the pathophysiology of early-onset schizophrenia involves neurodevelopmental impairment.     

Familial cancer of the ovary. A family with 6 index cases

Greggi and Kerlikowske have worked out that a woman has a 1.4% chance of developing ovarian cancer during her life. When cancer of the ovary is found, 5 to 10% of these cases have a familial form of this pathology. Thus there are some hereditary forms of cancer of the ovary and Lynch has demonstrated that there are three types of hereditary associations with ovarian neoplastic pathology: specific familial cancer of the ovary, cancer of the ovary associated with endometrial cancer and with non-polypoidal cancer of the caecum and rectum, cancer of the ovary associated with cancer of the breast. The clinical material we are presenting here is of the first type of association and we are reporting the study of a family in which 6 members in two generations had cancer of the ovary and of whom one had cancer of the breast as well. Familial cancer of the ovary shows different characteristics coming on as it does earlier (ten years earlier) and with a shorter length of survival (1.8 as against 5 years). The risk of the next generation having ovarian neoplastic pathology is clear because there is a 50% chance in a patient who has a history of cancer of the ovary in at least two first degree relatives. For most daughters when this type of familial cancer is found it is justifiable to carry out prophylactic oophorectomy from the age of 35 year onwards. Particular supervision should be carried out for patients who are members of a family where 2 index cases have been found within 20-35 years.(ABSTRACT TRUNCATED AT 250 WORDS)     

Age of onset of first alcohol intoxication and subsequent alcohol use among urban American Indian adolescents.

The objective was to assess the effect of early onset intoxication on subsequent alcohol involvement among urban American Indian youth. The data come from the American Indian Research (AIR) project, a panel study of urban Indian youth residing in King County, Washington. Data were collected annually from the adolescent and his/her primary caregiver from the 1988–89 school year to the 1996–97 school year, providing a total of nine waves of data. Early intoxication (by age 14) was related to delinquency, family history of alcohol abuse or dependence, poverty, broken family structure, less family cohesiveness, and more family conflict. The effects of these characteristics were, therefore, partialed out in testing effects of early intoxication on later alcohol involvement. Two-part latent growth models of alcohol use and alcohol problems were specified. Effects of early onset intoxication on these trajectories, as well as lifetime alcohol abuse or dependence by the transition to young adulthood, were examined. Findings indicate that adolescents who experienced their first intoxication early (by age 14), used alcohol more heavily from the ages of 16 to 18, experienced more problems related to the alcohol's use from the ages of 16 to 18, and were more likely to have a diagnosed alcohol disorder by the final wave of data collection. Congruent with similar studies in the general population, early intoxication appears to be associated with a deleterious course of alcohol involvement during adolescence and into the transition to young adulthood among urban American Indian youth. Implications for prevention are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Multiple endocrine neoplasia-type medullary thyroid carcinoma in three generations of a family

The familial accumulation of a multiple endocrine neoplasia (MEN) type 2a medullary thyroid carcinoma, is described based on the retrospective analysis of a family history. The proband was characterized by medullary carcinoma (MC) combined with phaeochromocytoma, her child had been shown to suffer from MC. In the third generation of the family C-cell hyperplasia and bilateral adrenal hyperplasia occurred. It is shown that in order to arrive at a correct decision as regards the therapy to be used, modern laboratory tests (serum calcitonin, CEA-analysis) and diagnostic imaging methods (ultrasound, computer tomography, magnetic resonance imaging, positron emission tomography, metaiodobenzylguanidine scintigraphy) should be used. It is emphasized that the available therapeutic means (surgery, radiotherapy, nuclear medicine) have to be carefully selected and, if necessary, combined. In medullary thyroid carcinoma associated tumours in other endocrine organs should be expected to occur. Family screening using blood chemical and genetic tests are recommended in asymptomatic cases, since their surgical treatment can in this way lead to complete recovery.     

Hospital psychiatry in transition. From the therapeutic community toward a rational eclecticism

Concepts derived from the paradigm of the therapeutic community have provided the main organizing principles for general inpatient psychiatry in the past 20 years. Increasingly, however, scientific studies have thrown doubt on the efficacy of current hospital practices. Changes in the broader social milieu have occurred as well since the therapeutic community was originally conceptualized, which raise questions about the "fit" between milieu therapy principles and current psychiatric needs. No current therapeutic paradigm is sufficient to encompass current inpatient psychiatric practice. There is a need for flexibility in utilizing various organizing principles for various aspects of the problems at hand. The paradigm of "problem-solving," derived from the research findings comparing group vs individual problem-solving, is an example of one way of examining and organizing data that could be applied to certain aspects of hospital care.     

Symbiosis, empathy, suicidal behavior, and the family

This paper discusses the theoretical concept of symbiosis, as described by Mahler and her co-workers, and its clinical applications in suicidal situations. Symbiosis is defined as both a developmental phase characterized by a lack of differentiation between self and others and a relationship which is contingent upon the family and social network. A disturbed symbiosis is a major component in a suicide attempt. The destructive aspects of symbiosis are traced together with its relationship to empathy and the efforts to both restore and resolve a symbiotic conflict through suicidal behavior. In family therapy a repetition of older symbiotic relationships is frequently observed. These are repeated from one generation to the next in order to keep the old relationship alive. Finally, the practical implications of the concept of symbiosis for assessment and treatment are discussed.     

Evans'' syndrome associated with Graves'' disease

A 36-year-old woman who had had Graves' disease for 6 years was admitted with severe thrombocytopenia. Evans' syndrome was diagnosed. The patient's family history showed multiple cases of Graves' disease but no cases of Evans' syndrome. Both conditions in this patient improved with corticosteroid and thiamazole therapy. Several autoimmune antibodies were found, but a common autoimmune mechanism was not clearly shown. Although the combination of Graves' disease and Evans' syndrome had not occurred previously in her family, genetic factors may play an important role in the pathogenesis of both conditions.     

A Life History Assessment of Early Childhood Sexual Abuse in Women.

Life history theory provided a framework for examining the relations among child sexual abuse (CSA), childhood adversity, and patterns of reproductive development and behavior. A community survey that assessed CSA, life history variables (e.g., age of menarche), and social and family background was administered to 623 women (mean age=26.9 years). Independent of social and family background, CSA was associated with earlier age of (a) menarche, (b) first sexual relationship, (c) desire to have children, (d) first childbirth, and (e) lower self-evaluated physical attractiveness. Cluster analyses revealed different patterns of experiential correlates of reproductive development within the group of abused women, suggesting CSA may operate in combination with other childhood circumstances to modify the timing and pattern of individual maturation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)