Changing Beliefs About Emotions in IBS: A Single Case Design.

BACKGROUND: Previous research suggests benefits of targeting beliefs about the unacceptability of emotions in treatment for irritable bowel syndrome (IBS). AIMS: The current study developed and tested an intervention focusing on beliefs and behaviours around emotional expression. METHOD: Four participants with IBS attended five group sessions using cognitive behavioural techniques focusing on beliefs about the unacceptability of expressing emotions. Bi-weekly questionnaires were completed and a group interview was conducted. This study used an AB design with four participants. RESULTS: Averages indicate that participants showed decreases in beliefs about unacceptability of emotions and emotional suppression during the intervention, although this was not reflected in any of the individual trends in Beliefs about Emotions Scale scores and was significant in only one individual case for Courtauld Emotional Control Scale scores. Affective distress and quality of life improved during follow-up, with only one participant not improving with regard to distress. Qualitative data suggest that participants felt that the intervention was beneficial, referencing the value in sharing their emotions. CONCLUSIONS: This study suggests the potential for beliefs about emotions and emotional suppression to be addressed in cognitive behavioural interventions in IBS. That beliefs and behaviours improved before outcomes suggests they may be important processes to investigate in treatment for IBS.

Isolated Gastric Variceal Hemorrhage Secondary to Idiopathic Sinistral Portal Hypertension.

Sinistral portal hypertension (SPH), also known as left-sided portal hypertension or segmental portal hypertension, is a rare cause of upper gastrointestinal bleeding. Historically, SPH is a result of obstruction of the splenic vein often secondary to pancreatic pathology. To our knowledge, there are no reported cases of idiopathic SPH in which the findings cannot be attributed to any etiology. It is important to do a detailed workup to rule out common pathologies of SPH before making a diagnosis of idiopathic SPH. Treatment of gastric variceal bleed secondary to idiopathic SPH can be challenging and requires a multidisciplinary approach with surgery and interventional radiology. Our patient's history, examination findings, and imaging revealed no identifiable cause for SPH suggesting idiopathic SPH. We describe a case of isolated gastric variceal hemorrhage due to idiopathic SPH that was successfully treated.

Do patients require outpatient follow-up after rapid referral double contrast barium enema?

INTRODUCTION: In our hospital, patients above the age of 40 years referred with a change in bowel habit without rectal bleeding undergo a double contrast barium enema (DCBE) ideally within 2 weeks. Results of benign studies are sent to a consultant colorectal surgeon and a routine clinic visit arranged. The aim of this study was to identify whether, following DCBE, patients (i) presented at a later date with colorectal cancer and (ii) needed assessment in clinic. METHOD: This is a review looking at all patients who underwent DCBE prior to routine clinic visit between January 2004 and December 2005. Hospital databases were cross-referenced to identify any patients presenting with a new diagnosis of colorectal malignancy between DCBE and April 2007. Clinic letters were reviewed to identify the number of outpatient visits prior to discharge and reasons for continued follow-up. RESULTS: During the study period, 521 patients (age range 31-93 years, 316 female) had DCBE prior to assessment in clinic. Diagnoses: cancer 48 (9.2%), polyps 13 (2.5%), colitis 3 (0.6%), no significant pathology 457 (87.7%). Of this latter cohort, 387 (84.7%) were discharged after one clinic visit; 54 (11.9%) attended twice and 11 (2.4%) were seen more than twice. Reasons for multiple attendances were management of haemorrhoids/anal fissure or investigations of unrelated symptoms. No new cancers were identified in this cohort between January 2004 and April 2007. CONCLUSION: Double contrast barium enema is a safe screening tool following a '2-week rule' referral with CIBH. Following a report of no significant pathology, there is no need to arrange routine follow-up.

COMT polymorphism modulates the resting-state EEG alpha oscillatory response to acute nicotine in male non-smokers.

Performance improvements in cognitive tasks requiring executive functions are evident with nicotinic acetylcholine receptor (nAChR) agonists, and activation of the underlying neural circuitry supporting these cognitive effects is thought to involve dopamine neurotransmission. As individual difference in response to nicotine may be related to a functional polymorphism in the gene encoding catechol-O-methyltransferase (COMT), an enzyme that strongly influences cortical dopamine metabolism, this study examined the modulatory effects of the COMT Val158Met polymorphism on the neural response to acute nicotine as measured with resting-state electroencephalographic (EEG) oscillations. In a sample of 62 healthy non-smoking adult males, a single dose (6 mg) of nicotine gum administered in a randomized, double-blind, placebo-controlled design was shown to affect α oscillatory activity, increasing power of upper α oscillations in frontocentral regions of Met/Met homozygotes and in parietal/occipital regions of Val/Met heterozygotes. Peak α frequency was also found to be faster with nicotine (vs. placebo) treatment in Val/Met heterozygotes, who exhibited a slower α frequency compared to Val/Val homozygotes. The data tentatively suggest that interindividual differences in brain α oscillations and their response to nicotinic agonist treatment are influenced by genetic mechanisms involving COMT.

Use of molecular probes to assess geographic distribution of Pfiesteria species.

We have developed multiple polymerase chain reaction (PCR)-based methods for the detection of Pfiesteria sp. in cultures and environmental samples. More than 2,100 water and sediment samples from estuarine sites of the U.S. Atlantic and gulf coasts were assayed for the presence of Pfiesteria piscicida Steidinger & Burkholder and Pfiesteria shumwayae Glasgow & Burkholder by PCR probing of extracted DNA. Positive results were found in about 3% of samples derived from routine monitoring of coastal waters and about 8% of sediments. The geographic range of both species was the same, ranging from New York to Texas. Pfiesteria spp. are likely common and generally benign inhabitants of coastal areas, but their presence maintains a potential for fish and human health problems.

Phialophora mutabilis endocarditis.

This is the first reported case of fungal endocarditis due to vegetative growth of Phialophora mutabilis on a prosthetic mitral valve. The patient had rheumatic heart disease with mitral and aortic stenosis. Four months after the mitral and aortic valves had been replaced by prostheses the patient developed congestive failure. Because of increased left atrial pressure, the mitral prosthesis was replaced. A large matted obstructive fungal vegetation was found on the prosthesis. Culture of this vegetation grew Phialophora mutabilis. The patient died postoperatively, and at autopsy the fungus was not found in other tissues. Culturally and morphologically, P. mutabilis shows wide variation in pigmentation, colonial and microscopic appearance. Conidia formation from intercalary cells along the hyphae is somewhat similar to that of Aureobasidium spp. P. mutabilis was injected into mice. Mice pretreated with cortisone died 3 to 5 weeks after intraperitoneal inoculation, while the majority of untreated mice died within 20 weeks of inoculation.

Distribution of mast cells in the axillary lymph nodes of breast cancer patients.

In a study of the pattern of distribution of mast cells in the axillary lymph nodes of 43 consecutive breast cancer patients it was observed that: 1) the pattern of distribution of mast cells in the survivors and nonsurvivors is similar, 2) there is almost complete absence of mast cells in the germinal centers with predominance of them in the T cell areas, and 3) a significant number of mast cells are seen in the afferent lymphatic route and the highest percentages of mast cells found in the medullary sinuses. The significance of these findings as they pertain to the relation of mast cells to the T cell system and to the migratory nature of mast cells is discussed.

Numbers of mast cells in the axillary lymph nodes of breast cancer patients.

This retrospective study of surgical specimens from forty-three consecutive patients treated by modified radical mastectomy for carcinoma of the breast shows that those patients surviving for at least sixty months after operation have a significantly greater number of mast cells in their axillary lymph nodes than the nonsurvivors (p less than .001). When expressed as cells/mm2 the survivors are associated with nodal concentrations greater than eleven mast cells per square millimeter while the nonsurvivors haver fewer than eleven mast cells/mm2. The results suggest that the number of nodal mast cells may be a readily quantitated host response of prognostic value in carcinoma of the breast.

Genetic polymorphism in Gymnodinium galatheanum chloroplast DNA sequences and development of a molecular detection assay.

Nuclear and chloroplast-encoded small subunit ribosomal DNA sequences were obtained from several strains of the toxic dinoflagellate Gymnodinium galatheanum. Phylogenetic analyses and comparison of sequences indicate that the chloroplast sequences show a higher degree of sequence divergence than the nuclear homologue. The chloroplast sequences were chosen as targets for the development of a 5'--3' exonuclease assay for detection of the organism. The assay has a very high degree of specificity and has been used to screen environmental water samples from a fish farm where the presence of this dinoflagellate species has previously been associated with fish kills. Various hypotheses for the derived nature of the chloroplast sequences are discussed, as well as what is known about the toxicity of the species.

Development of real-time PCR assays for rapid detection of Pfiesteria piscicida and related dinoflagellates.

Pfiesteria complex species are heterotrophic and mixotrophic dinoflagellates that have been recognized as harmful algal bloom species associated with adverse fish and human health effects along the East Coast of North America, particularly in its largest (Chesapeake Bay in Maryland) and second largest (Albermarle-Pamlico Sound in North Carolina) estuaries. In response to impacts on human health and the economy, monitoring programs to detect the organism have been implemented in affected areas. However, until recently, specific identification of the two toxic species known thus far, Pfiesteria piscicida and P. shumwayae (sp. nov.), required scanning electron microscopy (SEM). SEM is a labor-intensive process in which a small number of cells can be analyzed, posing limitations when the method is applied to environmental estuarine water samples. To overcome these problems, we developed a real-time PCR-based assay that permits rapid and specific identification of these organisms in culture and heterogeneous environmental water samples. Various factors likely to be encountered when assessing environmental samples were addressed, and assay specificity was validated through screening of a comprehensive panel of cultures, including the two recognized Pfiesteria species, morphologically similar species, and a wide range of other estuarine dinoflagellates. Assay sensitivity and sample stability were established for both unpreserved and fixative (acidic Lugol's solution)-preserved samples. The effects of background DNA on organism detection and enumeration were also explored, and based on these results, we conclude that the assay may be utilized to derive quantitative data. This real-time PCR-based method will be useful for many other applications, including adaptation for field-based technology.

Heteroduplex mobility assay-guided sequence discovery: elucidation of the small subunit (18S) rDNA sequences of Pfiesteria piscicida and related dinoflagellates from complex algal culture and environmental sample DNA pools.

The newly described heterotrophic estuarine dinoflagellate Pfiesteria piscicida has been linked with fish kills in field and laboratory settings, and with a novel clinical syndrome of impaired cognition and memory disturbance among humans after presumptive toxin exposure. As a result, there is a pressing need to better characterize the organism and these associations. Advances in Pfiesteria research have been hampered, however, by the absence of genomic sequence data. We employed a sequencing strategy directed by heteroduplex mobility assay to detect Pfiesteria piscicida 18S rDNA "signature" sequences in complex pools of DNA and used those data as the basis for determination of the complete P. piscicida 18S rDNA sequence. Specific PCR assays for P. piscicida and other estuarine heterotrophic dinoflagellates were developed, permitting their detection in algal cultures and in estuarine water samples collected during fish kill and fish lesion events. These tools should enhance efforts to characterize these organisms and their ecological relationships. Heteroduplex mobility assay-directed sequence discovery is broadly applicable, and may be adapted for the detection of genomic sequence data of other novel or nonculturable organisms in complex assemblages.