Needs of forensic psychiatric patients with schizophrenia in five European countries.

AIMS: The purpose was to compare the frequency of needs of patients with schizophrenia in forensic services across five European countries as assessed by both the patients and their care staff. METHODS: Patients with schizophrenia and a history of significant interpersonal violence were recruited from forensic psychiatric services in Austria, Germany, Italy, Poland and England. Participants' needs were assessed using the Camberwell Assessment of Needs-Forensic Version (CANFOR). Multiple linear regression analyses were used to identify predictors of numbers of needs. RESULTS: In this sample, (n = 221) the most commonly reported need according to patients (71.0%) and staff (82.8%) was the management of psychotic symptoms. A need for information was mentioned by about 45% of staff and patients. Staff members reported a significantly higher number of total needs than patients (mean 6.9 vs. 6.2). In contrast, staff members reported a significantly lower number of unmet needs than patients (mean 2.0 vs. 2.5). Numbers of total needs and met needs differed between countries. Unmet needs as reported by patients showed positive associations with the absence of comorbid personality disorder, with higher positive symptom scores and lifetime suicide or self-harm history. Significant predictors of unmet needs according to staff were absence of comorbid personality disorder and higher positive as well as negative symptom scores according to PANSS. CONCLUSIONS: Staff rated a significantly higher number of total needs than patients, while patients rated more unmet needs. This indicates that patients' self-assessments of needs yield important information for providing sufficient help and support.

Disseminated nocardiosis mimicking exacerbation of pulmonary sarcoidosis.

Nocardiosis is a rare, mixed suppurative and granulomatous, bacterial infection that can affect various organs, but most commonly lungs. Clinical manifestation is usually uncharacteristic; can mimic fungal, parasitic and mycobacterial infections or malignancy. Presentation can be also similar to that of the other granulomatous diseases, among them sarcoidosis. We present an unusual case of disseminated nocardiosis in a patient diagnosed before with sarcoidosis and treated with glucocorticoids. Clinical symptoms initially mimicked exacerbation of pulmonary sarcoidosis. The course of disease was severe.

A case of respiratory epithelial adenomatoid hamartoma of the sinonasal tract.

Respiratory epithelial adenomatoid hamartoma is a rare, non-neoplastic tumour characterised by an abnormal mixture of tissues that are indigenous to the region. REAH are shiny, polypoid, exophytic masses with a rubbery to firm texture. They may arise and co-exist in the setting of inflammatory polyps. We present a case of a 49-year-old patient who was referred to the department with a clinical diagnosis of chronic nasal sinusitis. Results of post-op histopathological examination show a mild change of the respiratory epithelium requiring, among others, differentiation from inverted papilloma and adenoid carcinoma.

Adenocarcinoma developes in the "cirrhotic" not just atrophic gastric mucosa.

Helicobacter pylori has been postulated as a group 1 carcinogen, but the mechanism of gastric carcinogenesis remains to be elucidated. It is believed that gastric cancer morphogenesis follows Correa's paradigm of a gastritis-->atrophy-->metaplasia-->dysplasia-->cancer sequence. The aim of the present study was to investigate by histology non-cancerous gastric mucosa in early gastric cancer. Forty cases of early gastric cancer were collected from the files. In all cases of well differentiated adenocarcinoma mucosal atrophy and intestinal metaplasia were present in non-cancerous gastric mucosa. In addition, focal glandular hyperplasia was present in 83.3% of cases and hyperplastic surface epithelium was present in 50% of cases. Mucosal atrophy and intestinal metaplasia were seen in 90.5% of poorly differentiated adenocarcinomas. This was accompanied by surface epithelium hyperplasia in 66.7% and glandular hyperplasia in 47.6% of cases. In a diffuse early gastric cancer atrophy was present in 71.4%, intestinal metaplasia in 57.1%, while hyperplasia (either surface epithelium or glandular) was present in 42.8%. With the introduction of Genta's "strict definition" of gastric mucosal atrophy it became clear that atrophic gastric mucosa is not just a case of simple atrophy but can be in some respect compared to a cirrhotic organ.

Synchronous carcinoma and primary MALT-lymphoma of the stomach. A report of two cases.

A synchronous presentation of an adenocarcinoma and a primary low grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) in the stomach is reported in a 73-year-old woman and a 55-year-old man. The diagnosis was based on microscopic examination of surgical specimens with immunohistochemistry. A possible etiology of the simultaneous presence of these two neoplasms in the stomach is discussed on the basis of our own material and review of the literature.

Lauren's and Goseki's grade distribution does not change along with the progression from an early to advanced gastric carcinoma.

It is generally believed that tumor progression is associated with increased cancer cell heterogeneity, poorer differentiation and increased malignant potential. We tested this hypothesis by comparing a group of early and advanced gastric carcinomas. We retrieved from our files 40 cases of early gastric carcinoma and another 40 cases of advanced gastric carcinoma. Routine tumor typing, grading (Lauren and Goseki classifications) and staging was applied. We have shown that the proportion of histological grades in early and advanced gastric carcinoma does not change significantly. In addition, more poorly differentiated carcinomas were present both in early and advanced gastric carcinoma groups. This is in contrast with several other studies. This fact together with overexpression of CD44V5 isoform and fewer cancer cells circulating in the blood of patients suffering from this type of gastric carcinoma might influence the adjuvant therapy strategy. In summary, in the present study we noticed a similar distribution of Lauren's and Goseki's histological grades both in early and advanced gastric carcinoma.

Lymph node micrometastases in early gastric carcinoma alone inadequately reflect the new model of metastatic development.

Forty early gastric carcinomas were studied retrospectively for the presence of micrometastases in the regional lymph nodes by cytokeratin 18 immunostaining. Tumor typing, grading and staging were reestimated and ploidy of the tumors was assessed with the CAS 200. Micrometastases were found only in 3 cases, while macrometastases were present in 6 cases (micrometastases were present in 3 of those 6 patients). Micrometastases had no effect on patients' survival. It has been concluded that in early gastric carcinoma micrometastases do not influence typing, grading, staging of the tumor and have no prognostic significance. It has also been concluded that it takes more than the diagnosis of micrometastasis alone to estimate its real prognostic significance, especially in view of the new by emerging concept of cancer metastatic development.

[PTSD--diagnostic criteria, clinical and certification application]. / Zespól pourazowego stresu--kryteria diagnostyczne, zastosowanie kliniczne i orzecznicze.

Diagnostic criteria and difficulties in diagnostics of the disorders caused by psychophysical trauma were discussed. Diagnoses of KZ-syndrome, post-traumatic stress syndrome in DSM-III, DSM-III-R, DSM-IV and "post-traumatic stress disorder" in ICD-10 were submitted to comparative analysis. Possibility of application of PTSD diagnosis in disability certification as well as forensic psychiatry was confirmed.

[PTSD as a result of a natural disaster]. / PTSD jako nastepstwo kleski zywiolowej.

A review of modern conceptions that may help in diagnosing of PTSD in the victims of flood in Poland in July 1997 was made. Diagnostic, epidemiological and prognostic problems in the development of the disorder were discussed.

[Mental disturbances in persons persecuted for political reasons in Poland in the years 1944-1955]. / Zaburzenia psychiczne u osób przesladowanych z przyczyn politycznych w Polsce w latach 1944-1955.

The paper presents the results of studies on the present state of mental health in persons persecuted for political reasons in Poland in the years 1944-1955. Symptoms of mental disturbances were detected in nearly all examined group. PTSD criteria were applied in the diagnosis.

[Was forensic psychiatry in Poland abused for political reasons?]. / Czy psychiatria sadowa w Polsce byla naduzywana dla celów politycznych?

With the aim of answering the question whether Polish forensic psychiatry was misused for political purposes the authors formulate several discussion question and try to describe the conditions protecting human rights of the person who is of interest to psychiatry and the law. The difficulties with formulating the concepts which define "misuse" are a result of the lack of more in-depth empirical research into this issue, the danger of using judgmental arguments and the need to retain an emotional distance in relation to the problem. While avoiding an unequivocal answer to this question several specific questions were selected, which may be helpful in formulating a more general assessment. The complexity and the polymorphous nature of the conditions which must be fulfilled before one may speak of the realization of the guarantee of human rights within the field of forensic psychiatry makes it possible to accept the notion that simply the existence of exterior laws regulating this legal issue is not enough to guard against the misuse of psychiatry. Nevertheless, the moral standards of psychiatrists, the legal functioning of the country and the adequacy of current laws in relation to medical knowledge are no less important. Final and unequivocal assessment of the role played by forensic psychiatry in the socio-political life of Poland in the past several decades may not be conducted without unbiased and scientific empirical research.

[The concept of social network as an example of modern diagnostic processes in forensic psychiatry]. / Koncepcja sieci spolecznej jako przyklad nowoczesnego postepowania diagnostycznego w psychiatrii sadowej.

The principles of using social network concepts in the aspect of current needs of modern forensic psychiatry in Poland were discussed.

[6 cases of bilateral melanoma of the uvea]. / Szesc przypadków obuocznego czerniaka blony naczyniowej.

Six patients with bilateral ocular melanoma were treated in the period 1967-1989. In one case both eyes were enucleated, in 4 one eye only, the other eye was treated. In all enucleated eyes the clinical diagnosis of melanoma was confirmed histopathologically. Two patients died because of metastases to the lungs and liver, one is alive and remains in a periodical control; there are no informations on the remaining 3 patients.

[Failures of brachytherapy in posterior uveal melanoma]. / Niepowodzenia brachyterapii w czerniaku naczyniówki.

PURPOSE: To estimate the risk factors responsible for unsuccessful treatment of melanoma with episcleral plaque brachytherapy. MATERIAL AND METHODS: Based on 23 cases of choroidal melanoma, in which the eyes had to be enucleated after earlier brachytherapy, clinical characteristics of the tumors, type of plaque therapy and reasons of enucleation were analysed. Histopathologic examination of enucleated eyes was performed by standard techniques and immunohistochemical stains on formalin-fixed paraffinembedded tumor tissues. RESULTS: Tumor size is the most valuable risk factor for prognosis in plaque brachytherapy of melanoma. The direct indications for enucleation were: increase of tumor mass, optic disc invasion, consecutive glaucoma and extrascleral extension. Histopathological examination revealed 17 mixed-cell melanoma, 4 spindle-cell, 1 epithelioid and 1 necrotic. Post-irradiation necrosis was found in only 6 tumors. CONCLUSIONS: It is very difficult to predict the results of conservative treatment of melanomas basing on their clinical characteristics. The aggressive nature of the tumors and their resistance to irradiation seem to be the likely explanation of failures.

[Scleritis resembling choroidal melanoma: a case report]. / Przypadek zapalenia twardówki nasladujacego czerniaka naczyniówki.

The clinical manifestations of the disease, its course and response to the therapy were typical of the inflammatory state in the eye. However, magnetic resonance imaging suggested the presence of an intraocular tumour. Immunoscintigraphic studies using technetium-labelled antimelanoma antibodies initially and 9 months later yielded positive results with the increasing antibody titer. Fine-needle aspiration biopsy did not reveal the presence of neoplastic cells. The eyeball was removed due to a chronic inflammatory process and loss of vision. Histopathological examination demonstrated a tumour-like lesion with the signs of inflammatory infiltration without mitotic activity.

[Attempts of orbit irradiation after enucleation of the eye with malignant choroidal melanoma. Part I]. / Próba naswietlania oczodolu po usunieciu oka z czerniakiem naczyniówki. Czesc I.

PURPOSE: The problem of orbit irradiation after enucleation of the eye with choroidal melanoma is controversial. We have decided to analyse our own material in order to estimate the effectiveness of this method. MATERIAL AND METHODS: The clinical material comprised 202 patients, 97 women and 105 men, in the age of 15-84 years, whose eyeballs were enucleated because of choroidal melanoma. In 72 patients the orbit was irradiated after enucleation with 60Co applicator (CKA4). The dose was about 50 Gy, 5 mm deep. The height of tumour, its location, histological type, infiltration of the sclera or beyond the eyeball and the treatment of tumour before enucleation were analysed. The follow-up time was 5-20 years. RESULTS AND CONCLUSIONS: The survival time of patients in the age below 30 years (p < 0.05) and of patients with choroidal melanoma of the height above 3 mm (p < 0.01) was significantly longer when the orbit was irradiated. Also the survival time of patients with scleral infiltration and with spindle-cell type of tumour was longer (but statistically not significantly) in those, whose orbits were irradiated after enucleation. Exenteration of the orbit was necessary in 4 cases not irradiated after enucleation, only in 1 case after irradiation. The probability of survival after irradiation of the orbit was significantly higher than in cases not irradiated (0.6971 vs. 0.6219). The estimated mean survival time (in months) was longer, but not significantly, in patients after irradiation of the orbit (197.017 vs. 181.409). We conclude that irradiation of the orbit after enucleation of the eye with choroidal melanoma should be recommended. Further investigations will be continued with collaboration of Institute of Oncology in Cracow.

B-mode and Doppler ultrasonography in pony mares with experimentally induced ascending placentitis.

REASONS FOR PERFORMING STUDY: Early, accurate diagnosis of ascending placentitis in mares remains a key challenge for successful treatment of the disease. Doppler ultrasonography has shown promise as a tool to diagnose pregnancy abnormalities and is becoming more available to equine clinicians. However, to date, no studies have prospectively compared this technique to standard B-mode measurement of the combined thickness of the uterus and placenta (CTUP). OBJECTIVES: The objective of the current study was to compare Doppler and B-mode ultrasonography for the detection of experimentally-induced ascending placentitis in mares. METHODS: Eleven healthy pony mares in late gestation were used in this study. Placentitis was induced in 6 mares between Days 280 and 295, while 5 mares served as negative controls. All mares were intensively monitored until delivery. Fetal heart rate, CTUP, uterine artery blood flow (resistance index, pulsatility index, arterial diameter and total arterial blood flow) and physical examination findings were recorded at each examination. Mares with an increased CTUP above published values were treated in accordance with published recommendations. Foals and fetal membranes were examined at birth. Ultrasonographic parameters were compared between groups using ANOVA. Foal viability and histological presence of placentitis were compared using a Fisher's exact test. RESULTS: The CTUP was increased above normal in 5 of 6 inoculated mares within 3 days after inoculation (P = 0.05). The sixth inoculated mare was excluded from subsequent data analysis. Uterine artery blood flow, physical examination findings and fetal heart rate were not different between groups. Gradual increases in CTUP, arterial diameter and total arterial blood flow were detected with increasing gestational age in the control mares (P = 0.02, P = 0.00001 and P = 0.00001, respectively). CONCLUSION: The CTUP, but not uterine blood flow, was different between groups (P = 0.00001). Recorded CTUP values for control pony mares were similar to previously published values for light breed horses.

[Extramedullary hemopoiesis presenting as a tumor of the posterior mediastinum in a patient with hemolytic anemia]. / Pozaszpikowe ogniska krwiotworzenia pod postacia guza sródpiersia tylnego u chorego na niedokrwistosc hemolityczna.

Extramedullary hemopoietic focus is a rare cause of tuberous enlargement of the posterior mediastinum. A 62-year-old man who had been diagnosed as having congenital spherocytic anemia 20 years ago, was admitted to hospital with initial diagnosis of pneumonia. Chest X-ray disclosed inflammatory infiltration in the lower lobe of the right lung and a tumor in the posterior mediastinum. Pneumonia subsided following treatment with antibiotics. Spiral computer tomography with concomitant transthoracic biopsy of the lesion, confirmed the presence of tumor located on the right side of the spinal column, as well as the presence of two minor focci on its opposite side. Cytological examination revealed extramedullary hemopoiesis. Differential diagnosis of tumor in posterior mediastinum, should take into consideration the possibility of extramedullary hemopoietic focci.