Culturing keratinocytes and fibroblasts in a three-dimensional mesh results in epidermal differentiation and formation of a basal lamina-anchoring zone.

The purpose of this study was to characterize an in vitro co-culture model in which fibroblasts grown in a three-dimensional nylon mesh were recombined with human keratinocytes. The cultures were kept for 3 and 5 weeks and then processed for electron microscopy. Keratinocytes showed reconstruction of an epidermis consisting of a basal layer with hemidesmosomes, a stratified epithelium with tonofilaments and desmosomes, a granular layer with keratinosomes and keratohyaline granules, and a transitional stratum corneum. Anchoring filaments, lamina densa, anchoring fibrils, bundles of elastin-associated microfibrils (diameters 10 nm) and fine collagen fibrils were formed. Collagen fibrils near the epidermis were much thinner than those in the lower levels. The present study shows that the dermal model containing metabolically active fibroblasts in their natural environment will support epidermal morphogenesis and differentiation including the formation of a basal lamina and anchoring zone.

Cerebral cysticercosis with reference to the natural history of parenchymal lesions.

The cerebral parenchymal response to degeneration of cysticerci was studied in 83 consecutive patients investigated over 5 1/2 years. Virtually all came from an endemic region of South Africa and 67% were children. Occasionally, computed tomography (CT) delineated an inert shower of cysticerci. The humoral and tissue reactions resulting from larval death cause intense cerebral edema and granulomata, which manifest particularly in the pediatric age group. Local and diffuse cerebral edema has not been stressed before nor has its incidence been evaluated. The shortest interval between cysticercal degeneration and its granulomatous response to the final radiographic calcification was found to be 25 months.

Endocarditis-related cerebral aneurysms: radiologic changes with treatment.

PURPOSE: To document the response of mycotic aneurysms to antibiotic therapy and correlate these findings with patient outcome. METHODS: Clinical findings, CT studies, and serial cerebral angiograms of patients with endocarditis related aneurysms seen over 10 years were retrospectively reviewed. RESULTS: In 14 patients infective endocarditis was diagnosed. The patients presented with subarachnoid haemorrhage (4 patients), stroke (9 patients), and seizure (1 patient). CT findings were intracerebral hematoma (5 patients), infarcts (4 patients), subarachnoid hemorrhage (4 patients), and aneurysms (2 patients). On angiography, 10 (71%) patients had single aneurysms, and 4 (29%) patients had multiple aneurysms. Eighteen aneurysms were detected, of which 6 (33%) were centrally located, and 12 (66%) were located peripherally. The most common site was the peripheral middle cerebral artery (56%). Serial angiography during antibiotic treatment demonstrated complete resolution of 6 aneurysms (33%), with 12 aneurysms remaining after 6 weeks of treatment. Of the latter, there was no change in size in 6 aneurysms (33%), a decrease in size in 3 aneurysms (17%) and an increase in size in 3 aneurysms (17%). No new aneurysms appeared. Surgery was performed on 10 patients with residual aneurysms, 11 aneurysms being excised or clipped. After 6 weeks' treatment, there was complete recovery in 7 (50%) patients, permanent neurologic deficits in 6 patients, and death from aneurysm rebleed in 1 patient. CONCLUSION: Follow-up angiography is recommended in all patients with mycotic aneurysms to assess response to antibiotic therapy, to detect new aneurysms, and to identify those aneurysms with no response or with enlargement.

Leigh disease (subacute necrotizing encephalomyelopathy): MR documentation of the evolution of an acute attack.

The radiologic evolution of Leigh disease is documented with sequential brain MR in the acute phase of the illness, at 3 weeks, and at 3 months. High-signal-intensity lesions seen on T2-weighted images in the first week resolved by 3 months, whereas new lesions appear during the chronic stage. Putamenal involvement is not a pathognomonic radiologic finding. Brain stem tegmentum, particularly the mesencephalon, is characteristically involved on MR in the early and late phases of the illness.

Rorschach and MMPI-2 indices of early psychotherapy termination.

This study was an investigation of the differences between 97 patients who had prematurely terminated psychotherapy (M = 1 session) and 81 who had participated in individual psychotherapy for at least 6 months and 24 sessions (M = 18 months/72 sessions) on selected Minnesota Multiphasic Personality Inventory--2 (MMPI-2) and Rorschach variables. None of the between-group comparisons using the MMPI-2 proved to be significant. However, a multivariate analysis of variance of 9 Rorschach variables in 3 conceptual categories--(a) interpersonal relatedness, (b) psychological resources versus resource demand, and (c) level of psychopathology--proved to be significant at p = .008. The Rorschach scores from the interpersonal-relational category proved to be the most robust in differentiating the 2 groups. The theoretical implications of interpersonal variables are discussed in relation to the termination and continuation of patients in psychotherapy.

Thrombophlebitis migrans in association with ulcerative colitis.

A case of thrombophlebitis migrans in a patient with ulcerative colitis is presented. The occurrence of thrombophlebitis was associated with an exacerbation of ulcerative colitis and responded well with the treatment of the underlying colitis. Evidence for a hypercoagulable state in ulcerative colitis is presented.

The effects of the vasoconstrictor epinephrine on the duration of pulpal anesthesia using the intraligamentary injection.

The use of the intraligamentary injection to achieve dental anesthesia is becoming a popular alternative to conventional dental techniques. This study compares the duration of anesthesia achieved by intraligamentary injection using lidocaine, lidocaine with epinephrine 1:50,000, lidocaine with epinephrine 1:100,000, and epinephrine 1:100,000. Using chi 2 and paired t-test analysis, there was no significant difference found in the efficacy of the agents studied in achieving pulpal anesthesia.

Utilization approaches and psychodynamic psychotherapy in a case of hospital phobia: an integrated approach.

Milton Erickson's approaches, including utilization techniques, were integrated with psychodynamically oriented psychotherapy in the treatment of a woman with a hospital phobia. The patient was a 28-year-old married woman who met the criteria for both Somatoform Disorder and Dependent Personality Disorder, and who had a variety of obsessive and compulsive personality traits. In trance the patient was given permission to replace many aspects of the hospital setting (e.g., driving to the hospital, checking in, talking with nurses, etc.) with interactions with certain emotionally meaningful people from her past. The outcome was that the hospital experience was quite pleasurable, as have been subsequent hospitalizations. Two years later, the patient discussed her hypnotic experience and reported an increase in positive transference and also an increase in her ability to cope with other difficult aspects of her life.

Assessing transitional phenomena with the transitional object memory probe.

Winnicott's concept of transitional relatedness has captured the interest of psychoanalysts because it provides an understanding of the dialectical process occurring between inner and outer reality, and by extension, between analyst and analysand. Clinical observations related to transitional phenomena have led the authors to develop a projective early memory probe that assesses transitional phenomena. The transitional object early memory probe was tested both for its empirical validity and for its clinical utility in psychodynamic psychotherapy. Construct validity was assessed by comparing memory scores to the Rorschach Transitional Object Scale, as well as to therapist ratings of patient behaviors. Results demonstrated moderate correlations between early memory scores and Rorschach scale scores. Equally important was the finding that early memory scores were significantly correlated with therapist ratings of key behavioral patterns in therapy. A case vignette highlights the clinical application of the transitional object probe in assessing the capacity for transitional relatedness. In this case, the data gleaned from the patient's memories provided the therapist with a sharper focus on their role in the patient's growing capacity for more vital and creative contact with reality.

Early memories: an exploration of theoretically derived queries and their clinical utility.

The authors take Mayman's (1968) procedure for gathering early memories as their point of departure by developing three theoretically and clinically relevant queries based on object relations theory. Two empirical studies were conducted to assess the projective potential and concurrent validity of these queries, while case vignettes illuminate their construct validity and clinical utility. The results of both studies and the case vignettes lend support to Mayman's theoretical conception of early memories as a unique and powerful projective tool.

John Exner and the book that started it all: a review of The Rorschach Systems.

This article is a review and a reassessment of Exner's (1969) The Rorschach Systems. The book reviews the history of the development of the Rorschach, primarily in the United States, including a detailed analysis of the progressive development of systems devised by Klopfer, Beck, Piotrowski, Hertz, Rapaport, and Schafer. The final versions of each system are compared with each other, and with Rorschach's own system. The development of the book is linked to Exner' s personal relationship with Klopfer, Beck, and Hertz. The book is described as the basic forerunner of Exner's Comprehensive System.

Maria Rickers-Ovsiankina: a Russian expatriate in America. A review of Rorschach Psychology.

This article is a review and reassessment of Rorschach Psychology, edited by Maria Rickers-Ovsiankina. The various chapters in the book are written with an attempt to tie Rorschach conceptualization to academic psychology and to various theoretical approaches. A wide range of theories are considered, including a gestalt psychology approach, an experiential-phenomenological approach, and several psychodynamic approaches (e.g., Freudian and Jungian theory). In addition, information is included about Rickers-Ovsiankina's early life and background, and the contents of many of the individual chapters are described and evaluated.

The interpreter's personality in Draw-A-Person interpretation: a study of interpersonal style.

This study investigated the relationship between accuracy in figure drawing interpretation and interpersonal style. Subjects were 66 undergraduates who completed the Minnesota Multiphasic Personality Inventory (MMPI), the Interpersonal Check List (ICL), and a figure drawing interpretation task. The MMPI and ICL were scored and interpreted using Leary's Interpersonal System, which provides for a multilevel assessment of interpersonal functioning. Interpretive skill was found to be associated with "affiliative" interpersonal styles (p < .05), and lack of interpretive skill was associated with "disaffiliative" interpersonal styles (p < .05) at two of the three levels examined. The role of unconscious processes in figure drawing interpretation, the nature of the interpretive process, and implications for the selection of skilled interpreters are discussed with reference to the interpersonal characteristics of the interpreter.

Psychological assessment on internship: a survey of training directors and their expectations for students.

We used a survey of internship training directors to examine the nature of assessment use and assessment skills training at 382 internship settings in professional psychology across the United States and Canada. For the purposes of this study, we created a questionnaire that inquired about the types of assessment instruments used at each internship setting, the amount and type of training offered at internship sites, and the type of assessment experience desired of interns before beginning their rotations. The results revealed several differences across type of internship facility surveyed as well as several trends in the current use of assessment in applied settings. The findings further demonstrate the important role of projective assessment in the training of graduate students and lead to the conclusion that major discrepancies may exist between what is being taught in graduate school and what students are expected to know on entering their internship positions.

A survey of graduate students' experiences, interests, and attitudes about learning the Rorschach.

A questionnaire about the experiences, interests, and attitudes of graduate students learning the Rorschach was sent to 235 student affiliates of the Society for Personality Assessment. The questionnaire asked for information concerning their Rorschach training in (a) class instruction, (b) adjunctive instruction (i.e., extraclass supervision and experiences at practicum sites), (c) research, and (d) personal experiences and views concerning this training. Seventy-one percent (166) of the questionnaires were returned. Results indicate that almost half the respondents gave from zero to four Rorschachs in their first course, that only half the students took a second course on the Rorschach, and that the Exner Comprehensive System was learned by a majority of the students. Students felt somewhat unsure of their skills concerning the formulation of Rorschach findings into concepts that could be communicated in a written report. Students reported that they lacked instruction concerning the research findings and application of the Rorschach. Students also did not feel grounded well enough in theory. Specific recommendations based on the information gathered from this survey are offered to improve teaching practices in the Rorschach as well as in personality-assessment training.