Tandem hypnosis with identical bulimic twins: case report.

Hypnosis has been used in the treatment of bulimia nervosa from the early 1980s. Dissociation theory identified a certain subgroup of eating disordered patients with dissociative signs and symptoms. These patients react well to hypnotherapy. Simultaneous hypnosis ("tandem hypnosis") in the treatment of two female 19-year-old monozygotic twins led to a very successful outcome after 6 sessions. During the therapy, attempts were made to work through the physical abuse the subjects suffered from their father. Hypnobehavioural methods were used and treatment was combined with five individual sessions. In the cases presented here, the subjects' traumatic history, their high hypnotic susceptibility, and the effectiveness of hypnotherapy seem to support the dissociative mechanism of symptom development. A systemic approach involving the integration of family therapeutical and hypnotherapeutical interventions proved to be useful. The role of these types of hypnotherapy interventions is still undervalued.

Cedar pollen aggravates atopic dermatitis in childhood monozygotic twin patients with allergic rhino conjunctivitis.

We report a case of 7-year-old monozygotic twin patients with atopic dermatitis. The HLA haplotypes were HLA A2, A11, B27, B61, DR1, and DR4. Both serum IgE levels and cedar pollen radioallergosorbent test (RAST) scores were high in the twins (elder/younger sister: IgE: 5170/3980 IU/ml and Japansese cedar pollen: >100/64.0) in contrast to low mite and food RAST scores (Dermatophagoides Pterygonium; 0.59/0.4 and egg white 9.24/4.6). The patients showed positive immediate (20 min in both sisters) and delayed (24 hours in elder sister, 24, 48, 72 hours in younger sister) reactions to a scratch test with Japanese cedar pollen. Skin lesions on the face were aggravated and extended to the trunk and extremities during the Japanese cedar pollen season and gradually subsided in summer. Oral provocation with egg white or cow milk showed no exacerbations, and topical corticosteroid did not improve the eczema. In contrast, successful protection from severe scratching behaviors was achieved by use of topical anti-allergic eye drops and wearing nightgowns made by the mother.

[Hyperbaric oxygen therapy of angiopathic changes in patients with inherited gene imbalance].

INTRODUCTION: Phenotype match inherited by genes is in most cases present in monozygotic twins. Their phenotypic resemblance is unfortunately characterized by strong susceptibility for the development of chronic non-infectious diseases. One of the most common non-infectious chronic diseases that are phenotipically represented in twins is diabetes mellitus. Genetic imbalance is, in most cases, placed in 2, 3, 7, 8, 11, 12, 19 and 20 chromosomal pair of the human genome. CASE OUTLINE: This study describes a pair of monozygotic twins, aged 54, who were diagnosed for diabetes type 2 ten years earlier. The first patient had trophic changes of muscles and skin tissues of the lower limb, and a necrotic wound on his right leg tibial region with the claudication distance of 50 m. After arteriography, he was referred by a vascular surgeon for hyperbaric oxygen therapy (HBO). HBO protocol implied 70 min. application of 100% oxygen at 2.5 absolute atmospheres. After the first series of HBO therapies consisting of 20 HBO treatments, claudication was eliminated and the necrotic wound healed. Next, surgical aortofemoral bypass was done. During the second HBO treatment, his monozygotic twin brother presented with angiopathic changes due to diabetes. In both patients, biochemical parameters corresponded to the expected level for diabetes type 2 imbalance, and the localization of the chromosomal defect (placed on 3, 11 and 19 chromosomal pair) was also in accordance with the respective disorder. After they were included into next 10 HBO treatments, Doppler imaging of the major arteries of limbs revealed normal findings. CONCLUSION: Identical genetic impairment in monozygotic twins can lead to identical somatic changes with resultant consequences. HBO treatment of such patients associated with other therapeutic procedures (conducted by diabetologist, vascular surgeon and physiatrist) can postpone or prevent irreversible changes occurring due to blood vessel disorders.

Bilateral ballismus in children.

Bilateral ballismus is extremely rare. We found 23 reported cases, and only 2 of these were in children. In older patients the movement disorder is usually due to cerebrovascular disease, but in younger patients a variety of aetiopathological causes may be found. There are few data regarding medical treatment. There have been no previous reports on stereotactic operations. We report on two severely disabled children who underwent stereotactic surgery. A 9-year-old boy suffering from bilateral ballismus after meningoencephalitis was operated on bilaterally (two operations 1 year apart). Another 9-year-old boy, who was suffering from progressive, presumably degenerative, basal ganglia disease, was operated on unilaterally. The nosological and conceptual controversies differentiating bilateral ballismus as a phenomenological entity are reviewed. The therapeutic options, indications, and special problems of stereotactic surgery in these rare cases are discussed.

[Ultrasonic monitoring of intravascular transfusion in severe Rhesus incompatibility. Diagnostic and therapeutic aspects after fetal relaxation]. / Die intravasale Transfusion unter Ultraschallkontrolle bei schwerer Rhesus Inkompatibilität. Diagnostische und therapeutische Aspekte unter Einfluss der intrauterinen Retardierung.

Since October 1985 47 ultrasound-guided intrauterine intravascular transfusions were performed in 14 patients at the Department of Obstetrics and Gynecology of the University of Ulm. All newborns were delivered in good condition. The successful diagnostic and therapeutic management of severe erythroblastosis in a twin pregnancy is described. The twin with severe signs of erythroblastosis had an initial hematocrit of 12% at 26 weeks of gestation. Intravascular transfusion of 60 ml packed red cells raised the hematocrit to 41%. The ascites disappeared completely ten days after the first transfusion. Two further transfusions were performed at 29 and 33 weeks of gestation. The intrauterine intravascular relaxation with Norcuron (Vecuroniumbromid) has proved advantageous in preventing interfering fetal movement. Both newborns were delivered in good condition at 36 weeks of gestation.