[Spirituality in schizophrenic diseases]. / Spiritualität bei schizophrenen Erkrankungen.

OBJECTIVE: The aim of this study was to investigate different dimensions of religiosity and spirituality among schizophrenic inpatients (F 2x) compared to addiction patients (F 10.2, F 19.2) and to healthy controls. In addition the dimensions of religious and spiritual well-being were examined and related to different parameters of mental illness. METHOD: The group of schizophrenic patients (n = 39) was compared to a group of addiction patients (n = 33) and a healthy control group (n = 38) by means of the multidimensional inventory for religious/spiritual well-being (MI-RSWB). Additionally, dimensions of RSWB were related to the Beck depression inventory (BDI) and the brief symptom inventory (BSI) in the group of schizophrenic patients. RESULTS: The group of schizophrenic patients did not differ from the addiction patients or from the healthy controls in the RSWB dimensions, except for the hope transcendent sub-dimension. Furthermore, dimensions of RSWB turned out to be negatively correlated with the severity of psychiatric symptoms (BDI and BSI). CONCLUSION: As assumed a positive relationship between RSWB and subjective well-being can be confirmed also for the group of schizophrenic patients. Existentially oriented dimensions such as hope and forgiveness might be specifically relevant for the group of schizophrenics.

Religious/Spiritual Well-being, personality and mental health: a review of results and conceptual issues.

The current paper provides background to the development of the Multidimensional Inventory for Religious/Spiritual Well-being and then summarises findings derived from its use with other measures of health and personality. There is substantial evidence for religiosity/spirituality being positively related to a variety of indicators of mental health, including subjective well-being and personality dimensions. Furthermore, religiosity/spirituality can play an important role in the process of recovering from mental illness as well as providing a protective function against addictive or suicidal behaviours. However, further research is needed to examine the mechanisms through which religiosity/spirituality have an impact on health-related conditions.

Soul darkness? Dimensions of religious/ spiritual well-being among mood-disordered inpatients compared to healthy controls.

BACKGROUND: Religiosity and spirituality have been found to be substantially associated with a variety of mental health and illness parameters. However, relevant empirical evidence is sparse, and more research is needed in order to further understand what role religiosity/spirituality plays in the development, progression and healing process of a psychiatric disease. Thus, the purpose of this study was to find out more information about the religious/spiritual needs of anxious/depressive inpatients. SAMPLING AND METHODS: A total sample of 200 well-characterized anxious/depressive inpatients was investigated. Results were compared to those from an adjusted group of healthy individuals (n = 200). A newly developed Multidimensional Inventory for Religious/Spiritual Well-Being was applied to both groups, together with established psychiatric measures (e.g. Beck Depression Inventory). RESULTS: Of the dimensions measured, Hope and Forgiveness turned out to be the strongest negative correlates of anxious/depressive symptoms (p < 0.001). Moreover, a lower degree of Hope (p < 0.001) and Experiences of Sense and Meaning (p < 0.01) was found in the patient group compared to healthy controls. In accordance with the literature, religiosity was confirmed to be a substantial suicidal buffer (p < 0.01). CONCLUSIONS: Our results account for a more comprehensive psychiatric evaluation, emphasizing in particular the role that religiosity/spirituality plays in overall well-being. Furthermore, religious/spiritual well-being might be considered an important resource to explore, in particular for affective mentally disordered patients.

Development of functionalized superparamagnetic iron oxide nanoparticles for interaction with human cancer cells.

Our goal is to develop, characterize and optimize functionalized super paramagnetic iron oxide nanoparticles (SPION) demonstrating the capacity to be internalized by human cancer cells. SPION (mean diameter 9nm) were coated with various ratios to iron oxide of either polyvinyl alcohol (PVA), carboxylate-functionalized PVA, thiol-functionalized PVA and amino-functionalized PVA (amino-PVA). The interaction with cells and cytotoxicity of the SPION preparations were determined using human melanoma cells. From the four functionalized SPION preparations, only the amino-PVA SPION demonstrated the capacity to interact with, and were not cytotoxic to, human melanoma cells. This interaction with melanoma cells was dependent on the amino-PVA to iron oxide ratio, was an active and saturable mechanism displayed by all cells in a culture. These functionalized SPION were characterized by transmission electron microscopy and electrophoretic mobility. The physical comportment of SPION changed at specific PVAs to iron oxide ratios, and this ratio corresponded to the ratio of optimal interaction with cells. In conclusion, the successful development of functionalized SPION displaying potential cellular uptake by human cancer cells depends both on the presence of amino groups on the coating shell of the nanoparticles and of its ratio to the amount of iron oxide.

Alternative methods for management of the complicated gallbladder.

Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. However, in the presence of acute cholecystitis, 10% to 15% of patients face conversion to laparotomy. Alternatives to conventional therapy may therefore help to improve the clinical outcome of patients with complicated gallbladder disease. In selecting patients for alternative therapies, preoperative and intraoperative factors must be considered. Preoperative factors include the severity of biliary disease and preexisting medical risk factors; whereas intraoperative factors include conditions at the time of surgery that make dissection difficult or unsafe. Alternative therapies provide the least invasive management to safely temporize or definitively treat the acute condition. These alternatives include percutaneous cholecystostomy alone or followed by laparoscopic cholecystectomy, laparoscopic cholecystostomy followed by laparoscopic cholecystectomy, laparoscopic subtotal cholecystectomy, endoscopic retrograde cannulation of the gallbladder, and extracorporeal shockwave lithotripsy. By appropriate selection of the initial therapeutic approach, the surgeon may ultimately improve the clinical outcome in these complicated patients.

Parathyroid hormone levels in preterm and term labor.

This prospective study was undertaken to test the hypothesis that parathyroid hormone (PTH) might be involved in preterm or term labor. Four groups of patients were formed, 15 patients in each group. The preterm labor group were patients who were admitted to our perinatal care unit with preterm labor and unruptured membranes (< 35 weeks' gestation). The preterm or term nonlabor control groups were patients matched for gestational age, maternal age, and parity, who were not in labor. The term labor group were patients matched for maternal age and parity who were in active labor. Mean (+/-SD) level of biologically intact PTH was 18.9 +/- 10.6 pgr/mL, 7.6 +/- 4.7 pgr/mL, 20.8 +/- 10.1 pgr/mL, 13.7 +/- 5.3 pgr/mL in preterm labor group, preterm nonlabor group, term labor group, and term nonlabor group, respectively (p < 0.05). No statistically significant differences were observed in the levels of calcium, phosphorus, magnesium, or albumin. We therefore suggest that PTH may have a role in preterm or term labor. The nature of its role should be investigated in further studies.

The cost effectiveness of preoperative autologous blood donations.

BACKGROUND: Since the recognition that human immunodeficiency virus is transmissible by blood transfusion there has been increasing public and professional support for autologous blood donations before elective surgery. Autologous blood donation is, however, a more expensive process than the donation of allogeneic blood by community volunteers. Furthermore, there have been recent improvements in the safety of the volunteer blood supply. METHODS: We used a decision-analysis model to assess the cost effectiveness of donating autologous blood for four surgical procedures. Cost data were collected from the observation of transfusion practice at the University of California, Los Angeles, in 1992. Estimates of the risks of transfusion-associated diseases and the costs of treating them came from the medical literature. Cost effectiveness was expressed in dollars per quality-adjusted year of life saved. We performed sensitivity analyses of the variables in our model and examined the effect of strategies suggested to reduce costs. RESULTS: Substituting autologous for allogeneic blood resulted in little expected health benefit (0.0002 to 0.00044 quality-adjusted year of life saved) at considerable additional cost ($68 to $4,783 per unit of blood). The additional cost of autologous blood was primarily a function of the discarding of units that were donated but not transfused and of a more labor-intensive donation process. The cost-effectiveness ratios ranged from $235,000 to over $23 million per quality-adjusted year of life saved. CONCLUSIONS: Given the improved safety of allogeneic transfusions today, the increased protection afforded by donating autologous blood is limited and may not justify the increased cost.

Protective effect of RibCys following high-dose irradiation of the rectosigmoid.

UNLABELLED: Ribose-cysteine (RibCys) is a prodrug of L-cysteine that stimulates glutathione biosynthesis. Increased glutathione levels have been shown to have a protective effect against radiation-induced injury and oxidative stress. Surface oximetry has previously been used successfully to predict anastomotic leakage. PURPOSE: The following study was done to evaluate the protective effect of RibCys and the predictive value of PtO2 determinations in a swine model. METHODS: Domestic swine were divided into three groups: Group A served as a nonradiated control; Group B received 6,000 to 6,500 rad to the rectosigmoid; and Group C received RibCys (1 g/kg) prior to receiving 6,000 to 6,500 rad. Radiated animals and controls underwent rectosigmoid resection after a three-week rest period. Intraoperative anastomotic PtO2 was checked with a modified Clark electrode. Anastomoses were evaluated radiographically at three and seven days; animals were sacrificed, and bursting strength was recorded at 10 days. RESULTS: Mean bursting pressures were 243.8 +/- 59.4, 199.5 +/- 37.8, and 209.5 +/- 54.9 mmHg (NS) for Groups A, B, and C, respectively. Anastomotic PtO2 ranged from 19 to 98 mmHg and could not be correlated with anastomotic leaks or bursting pressure. There were 11/15 radiation-related deaths and leaks (eight deaths and three leaks) in the radiated group and 4/12 radiation-related deaths and leaks (three deaths and one leak) in the group receiving radiation and RibCys (P < 0.04). CONCLUSIONS: 1) RibCys protected animals against radiation-related deaths and anastomotic leaks following high doses of pelvic irradiation; 2) anastomotic PtO2 levels did not correlate with anastomotic healing in this model.

Insulin-tumour interrelationships in EL4-lymphoma or thymoma-bearing mice. II. Effects of dietary omega-3 and omega-6 polyunsaturated fatty acids.

Male C57BL/65 mice received a basal diet supplemented with 4% soya-bean oil, linseed oil or fish oil, in which the major polyunsaturated fatty acids were linoleic acid, alpha-linolenic acid and long chain omega-3 fatty acids, respectively. Groups of animals were injected into the right flank with EL4-lymphoma cells, others with thymoma cells. Tumour implantation caused a gradual decrease in food consumption with both types of tumour, while body weight increased, especially in the EL4-bearing animals receiving the soya-bean diet. The weight gain was due to body water accumulation and was accompanied by decreases in body fat and minor changes in carcass protein and ash contents. The dietary treatments did not produce significant differences in tumour incidence and mortality, but tumour size was decreased by diets supplying omega-3 fatty acids: in the EL4 mice tumour weight was markedly depressed by linseed oil, compared to soya-bean oil, whereas thymoma tumour weight was lowest in mice receiving fish oil and highest in the soya-bean oil group. Both types of tumour caused pronounced hypoglycaemia and hyperinsulinaemia in the hosts, and the effect was modulated by the diets in the EL4 but not in the thymoma animals: the plasma glucose level was especially low in the linseed oil group and relatively highest in the soya-bean oil treatment. The degree of hyperinsulinaemia depended on the diet only in the thymoma-bearing mice, with linseed and fish oils producing higher insulin levels than soya-bean oil. A slight hyperinsulinaemia was also observed in linseed and fish oil-fed control mice. Serum triglycerides were elevated in tumour-bearing animals, without consistent differences between dietary treatments. Although no clear pattern emerged concerning total cholesterol and LDL levels, HDL values were strongly affected by the type of oil: in the control animals linseed oil caused an increase in HDL-cholesterol compared to the other two oils. The thymoma-bearing mice responded to the linseed and fish oil diets with greatly elevated HDL-cholesterol levels. The results point to important differences in the responses of the two implanted tumours and hosts not only to the omega-6 and omega-3 fatty acids, but also to the type of dietary omega-3 fatty acids, namely alpha-linolenic acid and long chain fish oil polyunsaturated fatty acids.

The role of acupuncture in asthma: changes in airways dynamics and LTC4 induced LAI.

A cohort of nine extrinsic asthma patients were treated by means of acupuncture. Patients were followed up for changes in medical treatment, spirometry, skin reactivity to immediate type reactions, total serum IgE levels and reactivity of their leukocytes to leukotriene C4 challenge (LTC4 induced leukocyte adherence inhibition (LAI) assay). Our results show that after acupuncture, treated patients were able to reduce bronchodilator and taper completely corticosteroid therapy. No change in skin reactivity or in IgE levels were noted. However, acupuncture treatment was able to negate, in 66.6%, the positive LTC4 induced responses.

Management of large filtering blebs with the argon laser.

Complications attributable to large conjunctival blebs after glaucoma filtering surgery range from annoying foreign-body sensation to devastating endophthalmitis. We used the argon laser to shrink large complicated blebs in four eyes of four patients who had previously undergone glaucoma filtering surgery. The eye is first anesthetized with a topical agent. The bleb surface is lightly abraded with a sterile cotton swab and then "painted" with a tissue-staining dye. Diffuse laser burns applied over the surface resulted in sufficient shrinkage to allow resolution of the respective symptoms or secondary complications in all four cases. The first two patients developed small leaks that we attribute to delivering laser burns to extremely thin areas of conjunctiva. In both cases the leaks gradually sealed over several weeks. None of the eyes developed increases in intraocular pressure or anterior segment inflammation. In each case, filtering capability was maintained.

Exacerbation of asthmatic symptoms after cessation of nifedipine therapy.

Marked improvement in the respiratory status of two patients with chronic obstructive lung disease was observed during treatment with nifedipine for angina pectoris. Cessation of the drug led to an exacerbation of asthmatic symptoms in both patients which necessitated initiation of bronchodilator therapy. Nifedipine is a known calcium antagonist and as such it has been suggested that it diminishes the transmembrane penetration of calcium ion into bronchial smooth muscle cells and mast cells, thus leading to bronchial muscle relaxation and less mediator release. The complication of increased asthmatic symptoms after cessation of nifedipine therapy has not been previously emphasized and should be taken into account while treating patients with known obstructive airway disease.