Psychological complications of patients with Gaucher disease.

The Minnesota Multiphasic Personality Inventory (MMPI-2) is commonly used in chronic illness and chronic pain populations to assess psychological functioning. We report the results of the first study employing the MMPI-2 to assess psychological aspects of patients with Gaucher disease, type I (GD) is an inborn error of metabolism with unique features as a chronic illness: the disorder often presents with mild symptoms, and is frequently diagnosed in later childhood or adulthood; the treatment is highly efficacious, but, that same treatment is intrusive and expensive and requires that patients restructure their work and personal schedules. In this study, 28 patients with GD completed the MMPI-2 and a background questionnaire. GD patients scored significantly higher than the MMPI-2 normative sample on MMPI-2 scales of Validity (K), Hypochondriasis (Hs), Depression (D), Hysteria (Hy), Psychasthenia (Pt) and Schizophrenia (Sc). Individuals with elevated scores on the Hs, D and Hy scales tend to have somatic concerns and depressed mood. Under stress, they are likely to report physical symptoms. Elevated Pt and Sc scales suggest psychological turmoil and, possibly feelings of isolation. An elevated K scale indicates a tendency for individuals to deny psychopathology. The length of time the patient with GD had been on enzyme replacement therapy was not significantly related to any of the 13 MMPI-2 scales. Cohorts of patients with chronic heart disease (CRHD) and cohorts of patients with chronic pain were utilized as comparative populations in this investigation. The elevated scores of the GD patients on MMPI-2 scales Hs, D and Hy were similar to those of the CRHD population. The chronic pain patients also showed elevations on MMPI-2 scales Hs, D and Hy, which were elevated in the GD patients; the elevations in the chronic pain patients were higher than those shown by the GD patients. We conclude that patients with GD exhibit moderate to severe psychological complications, similar to patients with other long-term chronic illnesses.

A comparison of the early inflammatory effects of an agr-/sar- versus a wild type strain of Staphylococcus aureus in a rat model of endophthalmitis.

PURPOSE: We examined the ability of a wild type and an isogenic mutant strain of Staphylococcus aureus, deficient in the production of hemolysins and lipase (agr (-)/sar (-)), to induce endophthalmitis and inflammatory cell infiltration into the eye at 6, 24 and 48 hours after injection in a rat model of endophthalmitis. METHODS: Rat eyes were injected with 25 microl of viable S. aureus or sterile saline. Eyes were graded for clinical signs of inflammation daily, removed and processed for standard histologic analysis 6, 24 and 48 hours after injections. Comparisons of clinical scores and mean inflammatory cell numbers were made between S. aureus and control injected eyes. RESULTS: Both experimental groups developed clinical signs of endophthalmitis and demonstrated infiltration of inflammatory cells at 24 and 48 hours. Clinical inflammation in the Mutant I group was less than the wild type group at these times and significantly less at 48 hours (p<0.05). No statistically significant difference in the number of inflammatory cells was detected between the wild type and Mutant I injected eyes at 24 hours. At 48 hours, inflammatory cells increased by 75.0% in the wild type group and decreased by 19.0% in the Mutant I group and a statistically significant difference was seen between these two groups (p<0.05). At all times, the majority of inflammatory cells were neutrophils. By 48 hours, an increase in monocytes-macrophages was noted. CONCLUSION: Both strains of S. aureus induced clinical signs of inflammation and inflammatory cell infiltration. Clinical inflammation and inflammatory cell numbers were less in rats injected with the Mutant I strain. These results suggest that hemolysins and lipase may be important in the early induction phase of the inflammatory response.