The practice of Modern Group Psychotherapy: working with past trauma in the present.

Modern Group Psychotherapy offers specific techniques for aiding the pre-oedipal patient to speak, connect, and achieve emotional growth. This article illustrates the use of such therapeutic group tools as joining, mirroring, bridging, contact functioning, the object-oriented question, the insulation barrier, and transient identification, through case vignettes. It demonstrates how such techniques protect fragile egos and assist them on their journey to maturity. Emphasis is placed on the creative components of countertransference as a valuable supplement in patient treatment. The power of the group as an agent for change is portrayed.

Characteristics of BRCA1 mutations in a population-based case series of breast and ovarian cancer.

Breast and ovarian cancers account for approximately 210000 newly diagnosed cases per year. More than half a million American women are estimated to be carriers of a breast cancer susceptibility gene. The purpose of this study was to assess the association of characteristics such as, age at diagnosis, race/ethnicity and family history of cancer with inherited BRCA1 mutations in a population-based sample of breast and ovarian cancer cases. No selection was made by race, age at diagnosis or positive family history of breast or ovarian cancer. The population under study was all breast cancer cases diagnosed in Orange County, CA, during the 1-year period beginning 1 March 1994 and all ovarian cancer cases diagnosed in Orange County during the 2-year period beginning 1 March 1994. This report focuses on the first consecutively ascertained 802 participating probands enrolled in the study, of which 9 were male breast cancer probands, 673 were female breast cancer probands and 120 were ovarian cancer probands. We observed 11 BRCA1 mutations or 1.6% (95% CI: 0.8-2.9) among the 673 female breast cancer probands and 4 BRCA1 mutations or 3.3% (95% CI: 0.8-8. 3) among the 120 ovarian cancer probands. No BRCA1 mutations were identified among the 98 non-white breast and ovarian cancer probands. The prevalence of BRCA1 mutations in non-Hispanic-white breast cancer cases below the age of 50 years was 2%. Positive family history of breast or ovarian cancers was significantly associated with BRCA1 mutation status among breast cancer probands. Similarly, positive family history of breast or ovarian cancer was significantly associated with BRCA1 mutation status among the ovarian cancer probands. In summary, we present results on the prevalence of BRCA1 mutations in a significantly larger sample of population-based breast and ovarian cancer cases than previously reported. The results indicate that, using a conservative approach to targeted genotyping of BRCA1, the frequency of mutations was consistent with those reported using similar methods of population-based case ascertainment.

Femoral stress abnormalities: improved scintigraphic detection with frog-leg view.

To identify a better scintigraphic imaging technique for detecting proximal femoral stress abnormalities, 51 consecutive patients with hip pain and the clinical suspicion of stress injury underwent three-phase bone scanning with technetium-99m methylene diphosphonate. Delayed scanning included anterior and frog-leg views of the hips. Fifteen patients had focal stress abnormalities of the femoral neck or lesser trochanter; all were detected with the frog-leg view, but only seven were detected with the standard anterior view. Stress abnormalities involving the lesser trochanter were depicted especially well on the frog-leg view.

Comparison of histamine release effects of ionic and non-ionic radiographic contrast media.

Histamine release may underline the side effects (particularly anaphylactoid) of radiographic contrast media. To study the histamine-releasing properties of radiographic contrast media, this study measured the in vitro release of histamine from human basophils incubated with diatrizoate, a standard ionic radiographic contrast agent, and with iopamidol, a newly developed non-ionic contrast agent. The basophils were separated from blood obtained from 16 patients scheduled for coronary angiography. For both diatrizoate and iopamidol, the concentration of histamine released varied as the concentration of radiographic contrast agent was increased from 0.075 M to 0.50 M. At the higher concentrations tested, the percent of histamine released by iopamidol was about half that released by diatrizoate (p less than 0.05). These data suggest that the use of non-ionic contrast media may involve less patient risk from the histamine-mediated allergic and/or hemodynamic side effects associated with radiographic contrast procedures.

Oxygen lowers intraocular pressure.

A significant decrease in intraocular pressure was demonstrated in 14 patients as atmospheric pressure was increased at intervals of 0.5 atmospheric pressure up to 3 atmospheres within a hyperbaric chamber. Nine of these patients had the identical protocol repeated in room air at atmospheric pressure without a significant change in intraocular pressure. Administration of 100% O2 at 15 L/min by partial rebreathing face mask to these patients using the same protocol at atmospheric pressure resulted in a significant decrease in intraocular pressure. The results in the oxygen and hyperbaric groups were not statistically different. While in the hyperbaric chamber, scleral rigidity increased uniformly, outflow facility decreased significantly, and keratometry readings remained unchanged. A significant decrease in intraocular prssure occurred in 20 rabbits that received 100% oxygen by partial rebreathing face mask for 180 minutes. Arterial blood gases were obtained at 0.90, and 180 min in seven rabbits. The pH and pCO2 did not change significantly; however, pO2 was markedly elevated. Increased oxygen concentration was felt to be responsible fot the decrease in intraocular pressure and the changes in other parameters observed in patients and rabbits.