Comorbid psychopathology and clinical symptomatology in children and adolescents with obsessive-compulsive disorder.

Comorbid psychopathology in children and adolescents with obsessive-compulsive disorder (OCD) has been investigated in a number of studies over the last twenty years. The aim of the present study was to investigate the phenomenology of illness and broader psychopathology in a group of Greek children and adolescents with OCD. The investigation of parental psychopathology in children and adolescents with OCD was a secondary aim of the present study. We studied 31 children and adolescents with OCD (n=31, age range 8-15 years) and their parents (n=62, age range 43-48 years) and compared to children and adolescents with specific reading and written expression learning disorders (n=30, age range 7-16 years) and their parents (n=58, age range 40-46 years). Appropriate testing showed specific reading and learning disorders, which were of mild to moderate severity for the 85% of this latter group. The diagnosis of learning disorder of reading and written expression was made through the use of standardized reading material, appropriate for ages 10-15 years. Reading comprehension and narration were tested. The written expression (spelling, syntax, content) was examined by a written text, in which the subject developed a certain theme from the reading material. Based on their level of education and occupation, the index families were classified as high (29%), average (45%) and low (26%) socioeconomic status, whereas 6.7% of control families belonged to high, 63.3% to average, and 30% to low status. In order to investigate psychopathology, the Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Life-time version was administered to children and their parents, as well as the Child Behavior Checklist 4/18 (CBCL) to both parents and adolescents (Youth Self-Report). Also the Yale- Brown Obsessive Compulsive Scale (Y-BOCS) was rated for both children and parents. Moreover, the children were given the Children's Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS). In the OCD group, 48% had contamination obsessions, 42% aggressive obsessions and 52% had washing and cleaning compulsions. Moreover, 32% had one additional disorder and 16.1% had two additional disorders. In comparison, only 17.2% of the control group children had one comorbid disorder. The OCD proband group had higher Total Problems score, as well as higher Anxiety/Depression, Thought Problems and Externalizing scores on the CBCL. When proband parents and control parents (29 mothers and 21 fathers) were compared, the percentage of fathers in the clinical range was significantly higher in the study group (Fisher's exact test: p=0.011, two tailed), whereas for mothers the difference did not attain significance (Fisher's exact test: p=0.106, two tailed). The fathers and mothers of children with OCD were more clinically affected than those of controls. Mothers of probands differed from controls in compulsions, compared to fathers, who differed in both obsessions and compulsions. Comorbidity rate was higher to children and adolescents with OCD. A considerable number of children and adolescents with OCD had higher symptomatology of anxiety and depression than controls, as well as higher rates of thought problems. Children and adolescents with OCD also exhibited higher rates of externalizing problems. This latter finding is considered as important and needs to be highlighted in terms of case management and treatment. Moreover, the parents of children and adolescents with OCD had more OCD symptomatology than the parents of children and adolescents with learning disorders. The symptomatology of the parents may create difficulties in interactions within the family and become burdensome for a vulnerable child. In turn, the child's symptomatology may create or increase some of the symptoms in the parents i.e. anxiety and depression. These findings suggest that at least for a percentage of children and adolescents with OCD, parental and especially paternal influence may contribute to the development and severity of their symptoms, not only through hereditary factors but also through the control exerted and the anxiety created in the family context.

Prognostic evaluation of tumour type and other histopathological characteristics in advanced epithelial ovarian cancer, treated with surgery and paclitaxel/carboplatin chemotherapy: cell type is the most useful prognostic factor.

AIM: Ovarian carcinomas have been classified into types I and II according to the hypothesised mode of carcinogenesis and molecular characteristics. The prognostic significance of this classification has not been studied. PATIENTS AND METHODS: Five hundred and sixty-eight patients with histologically confirmed, ovarian, fallopian tube or peritoneal carcinomas, international federation of gynecology and obstetrics (FIGO) stages IIC-IV, treated with paclitaxel/platinum following cytoreductive surgery, were included in this analysis. Type I included low-grade serous, mucinous, endometrioid and clear-cell and type II high-grade serous, unspecified adenocarcinomas and undifferentiated carcinomas. RESULTS: Median overall survival (OS) was 49 months for type I versus 45 for type II (p=0.576). In contrast to type II, there was considerable prognostic heterogeneity among the subtypes included in type I. Cox regression analysis showed that cell-type classification: low-grade serous, mucinous, endometrioid, clear-cell, type II (high-grade serous, unspecified adenocarcinomas, undifferentiated carcinoma) was an independent predictor of survival (respective median OS 121 versus 15 versus 64 versus 29 versus 45 months, p=0.003). On the contrary, histopathological subtype or tumour type (I versus II) did not offer additional prognostic information. CONCLUSION: The proposed model of ovarian tumourigenesis does not reflect tumour behaviour in advanced disease. Tumour-cell type is the most relevant histopathological prognostic factor in advanced ovarian cancer treated with platinum/paclitaxel.

Does the subjective quality of life of children with specific learning disabilities (SpLD) agree with their parents' proxy reports?

PURPOSE: The aim of the present study was to investigate agreement between child-parent proxy reports on quality of life (QoL) in children with specific learning disabilities (SpLD) and in a control group of typically developing children. METHODS: One hundred and sixteen children aged 8-14 years with SpLD, and 312 same age typically developing children with their parents (one or both), respectively, completed the child and parent versions of the KINDL(R) questionnaire. Values were analyzed with ANOVA and intra-class correlation coefficient (ICC). RESULTS: Significant mean differences were found between children with SpLD and their mother's proxy ratings. So, mothers reported significantly lower scores in the dimension of everyday functioning in school, but significantly higher scores regarding the child's physical and emotional well-being. For typically developing children, significant differences between children and parents' proxy ratings were found in physical well-being and self-esteem with both parents reporting higher scores. Concerning ICC, correlations were few and low in the SpLD group but more robust in the typically developing child-parent proxy ratings with values ranging from 0.22 to 0.46. CONCLUSION: In the case of SpLD, the child's problem area, which is reflected in the KINDL(R) dimension of everyday functioning in school, seems to be an issue of controversial value that may be differentially perceived by children and their mothers. Further, it can be argued that as mothers seemed to perceive in a more negative way the child's QoL at school, they were at the same time attempting to counterbalance their reactions by overestimating the child's physical and emotional well-being. Besides differences, there is a tendency even low for mothers and children with SpLD to converge toward similar perceptions regarding the child's physical and emotional well-being and satisfaction with friends that is showing some rather common understanding of the child's overall well-being and his/her relationships with peers. In the control group, agreement between children and parents seems to be more even and evident. Proxy assessments in children with SpLD and their parents may be useful for planning targeted support interventions for these families.

Hippocrates' counselling with regard to physical exercise, gymnastics, dietetics and health.

The aim of this study is the investigation of Hippocrates' consultative theory with regard to man's physical exercise, gymnastics, diet and health, on the basis of his work "Regimen" and his other works. The aforementioned issues are thematised in the works in question. By means of this thematisation, a medical counselling is formed, according to which exercise, gymnastics and diet aim at the maintenance and restoration of man's health; dietetics, maintenance of well-being, recovery and amelioration of man's health are involved in this thematisation. Hippocrates' views on the aforementioned issues constitute a basis for the discussion and pedagogical exploitation of them in contemporary education and, particularly, in sports education and physical exercise.

Is pyrazinamide really the third drug of choice in the treatment of tuberculosis?

SETTING: University Hospital in a rural area of Greece. OBJECTIVE: Pyrazinamide (PZA) is recommended as the third drug in the 6-month regimens for tuberculosis. This has replaced previously satisfactory 9-month regimens with ethambutol (EMB). Several cases of severe hyperuricemia and at least one episode of acute arthritis in patients receiving PZA prompted us to study PZA prospectively with regard to these side effects. DESIGN AND SUBJECTS: Prospective study of 20 patients receiving PZA for tuberculosis compared to control patients with tuberculosis not receiving PZA. RESULTS: The study was discontinued with the twentieth patient when it became obvious that uric acid was elevated in all patients while on PZA and the last patient developed acute arthritis. This occurred in none of the control patients. CONCLUSION: Hyperuricemia should either be considered a significant side effect and make us reconsider PZA as the third drug of choice in tuberculosis, or it should be officially declared trivial by a major health organization. If so, it should be suggested to all health providers involved that there is no need to monitor uric acid in tuberculosis patients receiving PZA.

Malignant pleural mesothelioma from nonoccupational asbestos exposure in Metsovo (north-west Greece): slow end of an epidemic?

Inhabitants of the Metsovo area, north-west Greece have been exposed since childhood to inhalation of asbestos, from a material containing tremolite, used for whitewashing ("luto soil"). This has resulted in endemic pleural calcifications (47% of adult population) and increased incidence of malignant pleural mesothelioma (MPM). In 1987, we reported that the incidence of MPM between 1981-1985 was around 300 times higher than expected in a nonasbestos exposed population (seven cases in 5 yrs in a population of 4,000-5,000). The present study is an updated report regarding this "mesothelioma epidemic", in conjunction with the diminished use and final abandonment of "luto soil" in the early 1980s. It appears that the incidence of MPM in Metsovo has dropped considerably since our first report. Between 1985-1994, we diagnosed six such cases (incidence rate = 1.4 cases per 10,000 person-years), whilst between 1980-1984 eight cases had been diagnosed (incidence rate = 3.7 cases per 10,000 person-years). Although, because of the small number of cases, this did not reach statistical significance (p = 0.08), we note that the incidence is now considerably lower than before. Had it remained unchanged, we would have expected 17 cases of MPM instead of six. This drop follows the diminished use of "luto" whitewash (by 92% of the population in 1950 and only 18% in 1980). If we take into account a 30-40 year latency period for mesothelioma, we expect that the "Metsovo mesothelioma epidemic" will fade away by the year 2020-2030, since the material has not been used since 1985.

Round atelectasis and Metsovo lung.

Round (helical) atelectasis is one of the benign sequelae of occupational asbestos exposure. Environmental asbestos exposure does not differ from occupational in its pleural manifestations, but to our knowledge, round atelectasis has not been reported yet. In the present study, we present the clinical and radiologic findings of five individuals with round atelectasis. They were all born in the Metsovo area, northwest Greece, where environmental exposure to asbestos (tremolite) has been documented. All five had negative evaluation for malignancy. In addition, they have been followed up for one to four years and four of them are in good health, thus confirming round atelectasis as a benign, nonpremalignant condition. The fifth patient died of malignant pleural mesothelioma two years later, while the previously detected round atelectasis remained unchanged. We therefore consider that his mesothelioma was not related to the round atelectasis, although both were certainly related to the same environmental asbestos exposure.

Lymphocytic alveolitis and pleural calcifications in nonoccupational asbestos exposure. Protection against neoplasia?

Inhabitants of the Metsovo area in Northwest Greece (population, 4,000) have been exposed to asbestos through the use of whitewash containing tremolite. This has resulted in endemic pleural calcifications (PCs) and increased incidence of malignant pleural mesothelioma (MPM). In order to evaluate the lung response to the fiber, bronchoalveolar lavage (BAL) was performed in 25 Metsovites; 14 with PCs, three with PCs and neoplasia, five without PCs, and three without PCs but with established neoplasia. There were no differences between the four groups with regard to age or exposure. Twelve Metsovites had lymphocytic alveolitis (BAL lymphocytes > 15%). Eleven belonged to the group with PCs and one belonged to the group without PCs. None of those with neoplasia had alveolitis. The lymphocytes were mainly helper T-cells, and activation markers were more frequent among those with PCs. We have previously reported on the relative absence of PCs in Metsovites with malignant pleural mesothelioma. This observation and the results of the present study suggest that lymphocytic alveolitis correlates with pleural calcifications, whereas both are rarely present in patients with neoplasia.

Dose rate distributions around 60Co, 137Cs, 198Au, 192Ir, 241Am, 125I (models 6702 and 6711) brachytherapy sources and the nuclide 99Tcm.

Simple analytical functions derived from our point source Monte Carlo calculations on the combined attenuation and scatter factor, B exp(-mu r), for 60Co, 137Cs, 198Au, 192Ir, 241Am, 125I (models 6702 and 6711) brachytherapy sources and the nuclide 99Tcm, for water spherical geometries of radii R = 15 and 20 cm, are presented. Our results for the broadly used 60Co, 137Cs, 198Au and 192Ir brachytherapy sources can be compared directly and found in excellent agreement with the widely accepted data of Meisberger et al in the limited distance range for which the latter are valid. Our data, however, can be used with high accuracy outside this distance range. Many discrepancies observed among different data sets available in recent literature are attributable to differences in geometries used. The results for the recently introduced 241Am source are very dissimilar to those produced by any other currently used brachytherapy source. Dose rate distributions, based on the above simple functions, are proposed in accordance with the recommendations for calibration of the brachytherapy sources in terms of reference air kerma rate and were found to be in good agreement with data available in the literature. Our calculations for 125I sources (models 6702 and 6711), provided that the characteristic x-rays from titanium encapsulation are taken into account, support recent experimental and theoretical dose rate distributions indicating that currently accepted values for 125I may be overestimated.

Accurate Monte Carlo calculations of the combined attenuation and build-up factors, for energies (20-1500 keV) and distances (0-10 cm) relevant in brachytherapy.

The combined build-up and attenuation factor, B exp (-mu r), of point isotropic photon sources in a water medium has been calculated using the Monte Carlo method, for energies (20-1500 keV) and distances (1-10 cm) relevant in brachytherapy. For the transport of photons and electrons, up-to-date and self-consistent total, partial and differential cross sections were used. The influence of coherent (Rayleigh) and incoherent (Compton) scattering, as well as the effects of the source and medium geometries on the calculations, were investigated in detail and it was found that these effects can lead to significant deviations from published data, especially at low energies and/or large distances from the sources. Our results can be used for any mono- or multi-energetic photon source in the energy range 20-1500 keV with uncertainties of the order of 2-3%, and they may influence treatment planning especially in the case of organs at risk which are usually near the edge of the body.