[The morphologic results of organ-sparing interventions in patients with renal tumor aged up to 40 years and older].

AIM: to evaluate the features pathologic results of organ-sparing interventions in patients aged up to 40 years and older and assess an influence of patient age on the recurrence-free survival in case of pathologically proven renal cell cancer. MATERIALS AND METHODS: A retrospective analysis of laparoscopic organ-sparing removal of kidney tumors in 314 patients performed from January 2012 to May 2017 was conducted. The mean patient age was 54.4+/-10.9 (25-78) years. There were 178 males (56.7%) and 136 females (43.3%). All patients were divided into two groups. In Group 1 a total of 37 patients aged less or equal 40 years (11.8%) were included and Group 2 consisted of 277 patients (88.2%) over 40 years. In Group 1 there was no family cases of renal cell cancer. RESULTS: In Group 1 malignant tumors were more common (n=33 cases (89.2%)), and benign tumors were diagnosed in 4 (9.8%) cases. Among patients older than 40 years the malignant and benign tumors were determined in 242 cases (87.4%) and 35 cases (12.6%), respectively. It was estimated that there were no differences in neither malignant tumors rate (p=0.75), nor in proportion of different pathologic forms of benign (p=0.68) and malignant neoplasms (p=0.25), nor in proportion of various degrees of anaplasia (=0.33). A mortality rate was 0.6% (2 patients in Group 2), and there was 3 relapse (1.1%). A proportion of censored cases was 99.4% for overall survival and 98.9% for recurrence-free survival. A point estimate of overall survival after 36-months follow-up was 35.77+/-0.16 months. The mean disease-free survival was 35.47+/-0.24 months. The survival differences between two groups were not significant due to absence of relapse and mortality in patients aged less or equal 40 years. CONCLUSION: During the planning of surgical treatment of patients with kidney tumors aged less or equal 40 years a preference to organ-sparing interventions should be given. The postoperative genetic counselling is recommended to exclude hereditary renal cell cancer. Considering a high risk of local recurrence in all patients aged less or equal 40 years meticulous and regular follow-up is needed.

Temporal scaling of neural responses to compressed and dilated natural speech.

Different brain areas integrate information over different timescales, and this capacity to accumulate information increases from early sensory areas to higher order perceptual and cognitive areas. It is currently unknown whether the timescale capacity of each brain area is fixed or whether it adaptively rescales depending on the rate at which information arrives from the world. Here, using functional MRI, we measured brain responses to an auditory narrative presented at different rates. We asked whether neural responses to slowed (speeded) versions of the narrative could be compressed (stretched) to match neural responses to the original narrative. Temporal rescaling was observed in early auditory regions (which accumulate information over short timescales) as well as linguistic and extra-linguistic brain areas (which can accumulate information over long timescales). The temporal rescaling phenomenon started to break down for stimuli presented at double speed, and intelligibility was also impaired for these stimuli. These data suggest that 1) the rate of neural information processing can be rescaled according to the rate of incoming information, both in early sensory regions as well as in higher order cortexes, and 2) the rescaling of neural dynamics is confined to a range of rates that match the range of behavioral performance.

Selective fovea-related deprived activation in retinotopic and high-order visual cortex of human amblyopes.

Amblyopia is a visual disorder starting at early childhood and characterized by reduced visual acuity not of optical origin or due to any eye disease. One expression of such an anomalous early visual experience is abnormal foveal vision. In a previous fMRI study, faces that were presented to amblyopic eyes evoked little response compared to houses in high-order visual areas. Patients also demonstrated reduced recognition of facial expression, raising the possibility that these face-selective abnormalities are related to foveal vision deficit. Whether this deficit originates in low-level processing or is mediated by compromised activation in high-order visual areas is unresolved. In the present functional magnetic resonance imaging (fMRI) study, we explored the impact of amblyopia on the representation of object images presented in foveally biased central versus peripheral retinotopic eccentricities through manipulation of object size. Small and large pictures were correlated to visual acuities of 6/6 and 6/60, respectively. In low-level visual areas, the amblyopic eye showed significantly reduced activation for centrally placed, small pictures than the sound eye, while activation to large pictures was only slightly reduced. Similarly, in high-order visual areas, the amblyopic eye showed marked reduction in activation in the fusiform gyrus, with normal activation in the collateral sulcus. The center/periphery size-related amblyopic outcomes of this study support a "bottom-up" nature of the center-periphery effect observed in high-order visual areas. Taken together, these findings point to the regional extent and functional selectivity of fovea-related cortical reorganization that is related to abnormal visual development of one eye.

Immigrants from the former Soviet Union, 5 years post-immigration to Israel: adaptation and risk factors for psychological distress.

BACKGROUND: Studies about the effect of time on the degree of psychological distress among immigrants have reported conflicting findings. We investigated this issue in Israel, which supports actively the absorption of immigrants, and also looked for risk and protective factors for psychological distress 5 years post-immigration. METHOD: A nationwide sample of 600 subjects who emigrated from the former Soviet Union to Israel in 1990 were interviewed in 1995, with the demoralization subscale of the Psychiatric Epidemiologic Research Interview (PERI-D) for psychological distress, and with a series of questions regarding sociodemographic characteristics, personal assets and their absorption experience. The results were compared with those obtained in a previous study for a sample of the same cohort of immigrants in their first year post-immigration. A multivariate analysis was carried out to examine the relation between the PERI score and the different independent variables. RESULTS: Although, 5 years after immigration, a favorable change in objective parameters of absorption was found, no decrease in psychological distress was observed. The main risk factors remaining significantly associated with psychological distress in the final model were: adverse life events, lack of perceived social support, poor family functioning, external locus of control, poor physical health status, non-identification with host society and, to a lesser degree, poor material conditions. CONCLUSION: Psychological readjustment apparently takes longer than other processes of adaptation. Several years after immigration, social and psychological factors have a more important role for the well-being of immigrants than their material conditions.

Area-specific amblyopic effects in human occipitotemporal object representations.

The role of early visual experience in the establishment of human high-order visual areas is poorly understood. Here we investigated this issue using human amblyopia--a developmental visual disorder, which manifests a central vision (acuity) deficit. Previous fMRI studies of amblyopes have described abnormal functional activations in early retinotopic areas. Here we report the surprising finding of a selective object-related abnormality in high-order occipitotemporal cortex. Specifically, we found that face-related cortical areas show a severe disconnection from the amblyopic eye, while building-related regions remain essentially normal. The selectivity of the deficit highlights the differential computations performed in the different object-related areas and is compatible with the suggested association of face regions with analysis of fine detail.

Object-completion effects in the human lateral occipital complex.

The ability of the human visual system to recognize partially occluded objects is a striking feat, which has received extensive psychophysical documentation. Here we studied the manifestation of completion effects in the functional magnetic resonance imaging (fMRI) activation of high-order object areas (the lateral occipital complex - LOC). Subjects were presented with three types of images: (i) whole line drawings of animal or unfamiliar shapes ('whole'); (ii) the same shapes, occluded by parallel stripes which occupied roughly half of the surface area of the images ('grid'); and (iii) the same stripes, 'scrambled' so that the relative position of the regions between the stripes was changed while the local feature structure remained intact. Behavioral measurements showed a high degree of object completion in the 'grid' condition, but not in the 'scrambled' condition. The fMRI results show a significantly higher activation to the 'grid' images compared to the 'scrambled' images. This enhanced activation indicates the operation of non-local completion effects, since the local features in both sets of images were the same. The cortical regions showing the highest 'completion' effects co-localized with regions in the LOC which showed the highest activation to the 'whole' images compared to the 'scrambled' images. Activation in early retinotopic areas was similar in both the 'grid' and the 'scrambled' conditions. Our results point to the LOC as a central site in which object completion effects are manifested.

Depression and anxiety disorders among Jews from the former Soviet Union five years after their immigration to Israel.

BACKGROUND: Epidemiological studies have shown that the prevalence rates of major depression and anxiety are lower in the elderly than in younger adults. In a recent survey, we found, among immigrants, that the association of age with psychological distress was the reverse. OBJECTIVE: The objective of the present study was to examine, among immigrants, whether the relationship of age with clinically diagnosed depression and anxiety disorders is also reversed. This was done by assessing the age-specific incidence and prevalence of depression and anxiety among immigrants from the former Soviet Union to Israel five years after their immigration. METHODS: A stratified subsample was chosen from a larger random sample of immigrants from the Former Soviet Union who arrived in Israel in 1990. We selected the subsample to include an over-representation of those with a high level of distress in order to increase the probability of finding people suffering from psychopathology. The subjects were interviewed with a diagnostic instrument, the CIDI-S, an abbreviated version of the CIDI. Prevalence and incidence rates of depression and anxiety were calculated separately for two age groups (those below age 65 and those aged 65 and above). RESULTS: Before immigration, incidence rates were lower among the elderly than among younger adults, a finding consistent with the literature. However, after immigration, the reverse was found, with higher prevalence and incidence rates among elderly immigrants. CONCLUSION: The data suggest that immigration contributes to an increase of psychopathology which is particularly pronounced among the elderly.

A hierarchical axis of object processing stages in the human visual cortex.

How are objects represented in the human visual cortex? Two conflicting theories suggest either a holistic representation, in which objects are represented by a collection of object templates, or a part-based representation, in which objects are represented as collections of features or object parts. We studied this question using a gradual object-scrambling paradigm in which pictures of objects (faces and cars) were broken in a stepwise manner into an increasing number of blocks. Our results reveal a hierarchical axis oriented anterior--posteriorly in the organization of ventral object-areas. Along this axis, representations are arranged in bands of increasing sensitivity to image scrambling. The axis starts in early visual areas through retinotopic areas V4/V8 and continues into the lateral-occipital sulcus dorsally and the posterior fusiform girus ventrally, corresponding together to the previously described object-related lateral occipital complex (LOC). Regions showing the highest sensitivity to scrambling tended to be located at the most anterior-lateral regions of the complex. In these more anterior regions, breaking the images into 16 parts produced a significant reduction in activation. Interestingly, activation was not affected when images were cut in two halves, either horizontally or vertically. Car images generally produced a weaker activation compared to faces in the lateral occipital complex but showed the same tendency of increased scrambling sensitivity along the anterior--posterior axis. These results suggest the existence of a hierarchical axis along ventral occipito-temporal object-areas, in which the neuronal properties shift from sensitivity to local object features to a more global and holistic representation.

[The current compulsory hospitalization order and patients' rights].

Israel's "Treatment of Mentally Sick Persons Law" of 1955 was repealed and replaced by the "Treatment of Mental Patients Law" of 1991. Under the latter, the "Compulsory Hospitalization Order" (CHO) defines the new order based on accumulated experience with the old legislation, and on the philosophy that considers the CHO one of the most severely oppressive forms of deprivation of human liberty and rights. The new order sets limits and boundaries for CHO, guarding the rights of those unavoidably committed by force. According to the new law, the district psychiatrist decides upon and issues the order, while the tribunal (District Psychiatric Committee) considers appeals. The order is limited to 1 week, with an option for the district psychiatrist to prolong it on written request for up to 14 days. The tribunal can later prolong the order further. The objective of this study was to review changes that have occurred following enforcement of the new law in the Jerusalem district. A comparison was made between CHO's issued the year before the new legislation took effect and the year after. The comparison included review of all CHO's and medical files of all patients hospitalized by coercion during 1990 and 1992. It was assumed that there would be a decline in rate and length of hospitalization of patients forced to be committed by the new law. The main findings refuted this hypothesis. In 1992 there was an increase of 38% in the number of compulsory hospitalizations. This increase derived mainly from increased demands for CHO's from psychiatric emergency rooms. There was also an increase in patients hospitalized by order of the District Psychiatric Committee using its authority under section 10(C) of the law. Conversely, length of compulsory hospitalization was shorter under the new law. In light of these findings, it would seem that the new law has only partially fulfilled expectations of reform in individual rights. There is need for further evaluation and follow-up of the CHO in order to determine whether the "Treatment of Mental Patients Law" of 1991 has in fact fulfilled its objectives. Furthermore, it is necessary to determine means, medical or legal, that may possibly advance further the prospective of human rights while maintaining a suitable balance between civil liberties and clinical needs, of over-confinement versus under-treatment, which may lead to neglect or danger.

[Symptom severity among chronic schizophrenics in hospital and in the community].

We compared severity of symptoms of chronic schizophrenics in a psychiatric hospital with those treated in its outpatient clinics. The Positive and Negative Syndrome Scale and the Mini-Mental State examination were used to assess the schizophrenic symptoms and cognitive performance, respectively, of 25 chronic schizophrenic inpatients matched for gender, age and education with 25 chronic schizophrenic outpatients. The Global Assessment Scale and the Clinical Global Impression Scale were used to test global functioning. Assessment included psychiatric and medical history and treatment and demographic characteristics. In-patients had significantly more positive, negative and general psychiatric symptoms. Their cognitive and general functioning were impaired. Most in-patients also had medical problems. Age of onset of schizophrenia among the in-patients was younger. Results show a marked difference in severity of symptoms and level of functioning between chronic schizophrenic in-patients and out-patients. These differences should be considered in the planning of discharge of chronic in-patients from psychiatric hospitals into the community.

[Folic acid deficiency in chronically hospitalized mental patients].

Studies over the past 30 years have shown a relationship between folic acid deficiency and psychopathology. FA deficiency was observed more often in depressed and in psychotic patients, in alcoholics, in those suffering from organic mental disorders and in the psycho-geriatric population. In a chronic inpatient population of 120 patients, of the 106 in whom FA serum levels were examined, only 1 had a definitely subnormal level. An additional 16 had close to the lower limit of normal (2 ng/ml) and were considered borderline cases. FA-deficient and borderline patients were then compared to matched patients with normal FA levels on the MMSE and PANSS scales by blinded raters. Small differences were found between the 2 groups. The FA-deficient and borderline patients had more organic and psychotic symptoms, but the differences were not statistically significant.

[Impaired physicians: the Israel Intervention Program].

Diagnosis and treatment of mental disorders among physicians is a complicated problem. In western countries alcohol and drug abuse are the main mental problems of physicians, and programs of early treatment help them keep their practices without their harming their patients. We describe the activities of the Israel Committee for Psychiatric Examination of Physicians in 1989-93, when 115 physicians were examined. Addiction to alcohol or drugs was rare, but mental illness was detected in 50% of those examined. The results indicated that the committee acted therapeutically, dictating mental treatment and following up on it. Due to this policy, in most cases physicians were enabled and allowed to continue their practices. The results emphasize the need for occupational mental health facilities for physicians and other medical professionals.

Prior hospitalization and age as predictors of mental health resource utilization in Israel.

A two-part demand model based on data from a psychiatric case registry was estimated in order to search for predictors of hospital-based psychiatric care utilization. Using only age as an independent variable, explanation of future resource utilization is considerably weaker than when number of cumulative days of psychiatric hospital-based service use during the previous five years is also included. Only a small marginal gain is achieved by also adding diagnoses. Prospective remuneration by capitating sick funds according to age and past hospital-based service utilization records is recommended to avoid the twin pitfalls of cream-skimming and a distorted allocation of resources for psychiatric services.

Behavioural problems of children with chronic physical illness and their siblings.

Children suffering from chronic physical illness are considered to be at increased risk for behavioural problems. There is also evidence that their siblings are at risk for behavioural problems. This study investigated parent-reported behavioural problems in chronically ill children and their siblings. There were significant positive correlations between the behaviour problem scores of the ill children and the scores of their siblings. Siblings older than the ill child had significantly higher behaviour problems scores of an internalizing nature than did the younger siblings. Sibling behaviour problem scores were similar to those of a comparison group of normal children and significantly different from those of a comparison group of psychiatrically referred children. Siblings of chronically ill children showed no greater likelihood of receiving scores in the clinical range of behaviour problems than children in the general population. Implications of the findings and suggestions for future research are discussed.

Ambulatory mental health treatment under universal coverage: policy insights from Israel.

Untested assumptions concerning ambulatory treatment have shaped mental health policies for decades. Three opinions prevail: (1) all use is alike; (2) any use leads to high use; and (3) all high use is discretionary and therefore excessive. These assumptions were tested, using data from a nationwide survey of ambulatory utilizers in Israel, a country that has universal coverage. The findings, based on detailed clinical and treatment records, challenge all three assumptions. Moreover, they document a diversity of clinical needs while also verifying substantial variations in the type, frequency, and duration of treatment provided to meet those needs. In brief, Israeli data do not confirm continuing concerns by policy makers about uncontrollable use of services with expanded mental health coverage. Special policy limitations on mental health treatment should be reconsidered in light of empirical evidence from a system without the restrictions that exist in the United States.

[Patterns of service utilization of mental health outpatients].

In light of the forthcoming implementation of national health reform, it is important to review and analyze data regarding the degree and pattern of outpatient, mental-health service utilization in Israel. The main questions this study addressed were: to identify the main groups of users of mental health care, and to determine the utilization patterns of these groups (by length, frequency, and type of treatment) and the profession of the caregivers. This study is based on the findings of the national survey of all adult users of ambulatory mental health services in 1 week in May 1986, and of a 1-week survey in 1994 of similar data from 7 mental health clinics. When patients were grouped into 2 main clinical categories according to the severity of their psychopathology (psychotic, major affective and organic disorders, vs. neurotic, adjustment and personality disorders) they showed different patterns of service utilization. The pattern of the first group was associated with the severity of the psychopathology, whereas the pattern of utilization of the second group was also associated with sociodemographic factors, which may reflect awareness of psychological problems and readiness to turn to mental health services. These factors may also affect the willingness of the caregiver to treat them.

Psychological distress among recent immigrants from the former Soviet Union to Israel, I. Correlates of level of distress.

In most migrations some selection takes place either by the absorbing country and/or the individuals who emigrate. Israel has an open-door policy for immigrants and the recent large wave of immigrants from the former Soviet Union was made up of entire families rather than individuals. This provided an opportunity to examine the issue of migration and psychological distress more directly. A nationwide sample of 600 immigrants who arrived during the preceding year were interviewed in December 1990. Their psychological distress was measured by the PERI Demoralization questionnaire. For both genders, the mean demoralization score of the immigrant sample was found to be significantly higher than that reported for the Israeli-born population (after controlling for education). The factors that were found to be correlated with the level of distress were mostly individual characteristics of the immigrants (e.g. profession, religiousness, former residence in the Chernobyl region, previous contact with the health profession because of psychological problems). Increased distress was also significantly related to perceived lack of social support in Israel, which may in fact be partly determined by personality traits.

Psychological distress among recent immigrants from the former Soviet Union to Israel, II. The effects of the Gulf War.

The psychological effects of the Gulf War were studied on a group of Israeli civilians particularly at risk, viz. recent immigrants from the former Soviet Union. A quasi-experimental design was used. A sample of immigrants who had already been screened for psychological distress just before the war were reassessed after the war with the same instrument (PERI demoralization questionnaire). Various parameters related to the war period were also assessed. Psychological symptoms during the war were significantly associated with pre-war level of distress and with actual physical harm from the missiles, but not with exposure to danger (proximity of residence to areas hit by missiles). Correlates of behaviour in the face of life-threatening danger during the war (change of residence and help-seeking behaviour) were also identified. Overall the level of post-war psychological distress was not found to be higher than pre-war levels. This was explained by the immigrants' feelings of shared fate, belonging and sense of cohesion, which characterize the general Israeli population during war time.

Brief report: circadian melatonin, thyroid-stimulating hormone, prolactin, and cortisol levels in serum of young adults with autism.

An abnormal circadian pattern of melatonin was found in a group of young adults with an extreme autism syndrome. Although not out of phase, the serum melatonin levels differed from normal in amplitude and mesor. Marginal changes in diurnal rhythms of serum TSH and possibly prolactin were also recorded. Subjects with seizures tended to have an abnormal pattern of melatonin correlated with EEG changes. In others, a parallel was evidenced between thyroid function and impairment in verbal communication. There appears to be a tendency for various types of neuroendocrinological abnormalities in autistics, and melatonin, as well as possibly TSH and perhaps prolactin, could serve as biochemical variables of the biological parameters of the disease.

An unusual effect of ECT on drug-induced parkinsonism and tardive dystonia.

A patient with schizoaffective disorder and anticholinergic refractory neuroleptic-induced parkinsonism manifested a marked increase of parkinsonian symptoms and dystonia after ECT. This is the first report in the literature of such an unusual reaction of parkinsonian and dystonic symptoms to ECT.