Palmar Fasciitis and Polyarthritis Syndrome: A Rare Paraneoplastic Syndrome in a Patient With Prostate Carcinoma.

A 73-year-old patient was seen in our hospital for treatment of metastatic adenocarcinoma of the prostate (pT1aN0M1a R0, BRCA-2 gene mutation). Prostatectomy and regional radiotherapy were performed and goserelin, a luteinizing hormone-releasing hormone (LHRH) analog, had been started because of disease progression. Castration-resistant progressive disease developed, and enzalutamide was added. A decrease of the prostate-specific antigen (PSA) level was achieved. Before the start of enzalutamide, the patient developed bilateral pain and stiffness of both hands combined with thickening of the hands. The symptoms progressed rapidly to bilateral flexion and extension contractures. The patient became unable to tie his shoelaces and had to use adjusted cutlery to eat. Consultation of the rheumatologist, X-rays, ultrasound and palmar skin biopsy of the hands were performed. The clinical picture resembles descriptions of "palmar fasciitis and polyarthritis syndrome" (PFPAS), a rare paraneoplastic syndrome. Positive effects of immunosuppressive medication have been reported in some cases. In our patient, treatment with oral prednisone (30 mg daily) showed no effect, therefore treatment was switched to methylprednisone pulses and methotrexate. PFPAS is an uncommon paraneoplastic syndrome characterized by rapid onset of bilateral arthritis of the hands, fasciitis of the palms, progressive stiffness and contractures. The scarcity of knowledge about PFPAS makes it difficult to recognize it at an early stage. As a paraneoplastic syndrome, it has been linked to various malignancies. Thus far, PFPAS has been described in only two other cases of prostate cancer.

The effect of active and passive peer encouragement on adolescent risk-taking.

INTRODUCTION: In this experiment, we investigated the effect of active (pressure) and passive (imitation) peer encouragement on adolescent risk-taking and assessed gender differences. METHOD: The participants performed the Balloon Analogue Risk Task (BART) with the same-sex e-confederate. The experiment consisted of a 2 (passive encouragement: no/yes updates about the number of pumps of the e-confederate) by 2 (active encouragement: no/yes messages received from the e-confederate) by 2 (gender: girls/boys) by 3 (time: baseline/first message or update/second message or update) mixed design. The participants comprised 138 Dutch secondary-school students aged 11-19 years old of whom 46% boys. They were assigned to one of the four conditions: 1. neutral (e-confederate present), 2. passive (two updates received), 3. active (two messages received), or 4. combined (two updates and two messages received). RESULTS: Only a significant main effect of passive peer encouragement and a significant interaction effect of passive peer encouragement*time were shown. The participants exposed to passive peer encouragement took significantly more risk compared to other participants. Moreover, adolescent risk-taking significantly increased after the first and second update compared to baseline (no update). CONCLUSION: The findings suggest that adolescents are more likely to engage in risk-taking because of passive rather than active peer encouragement. Thus, communication through text-based messages in which young people provide information solely about their own risk-taking may be an important aim of prevention and intervention programs.

The Effect of Active and Passive Peer Discouragement on Adolescent Risk taking: An Experimental Study.

This experiment investigated the effect of peer discouragement on adolescent risk taking. Overall, 269 Dutch adolescents aged 11-15 years completed a risk taking computer task in the presence of an e-confederate who demonstrated very little risk taking (passive peer discouragement) and/or sent risk-discouraging messages to participants (active peer discouragement). The results showed that, compared to a situation with no peer discouragement, adolescents took significantly less risk only when they encountered a combination of active and passive peer discouragement; hence, when peers practiced what they preached. No gender differences were found in the effect of passive and active peer discouragement on risk taking. The results showed that digital peer messages play a promising role in diminishing adolescent risk taking.