Efficacy of Extracorporeal Photopheresis in Patients With Bronchiolitis Obliterans Syndrome After Lung Transplantation.

BACKGROUND: Lung transplantation (LT) is only therapeutic option for patients affected by chronic respiratory failure. Chronic rejection, also known as bronchiolitis obliterans syndrome (BOS), is still the main cause of death and the most important factor that influences post-transplantation quality of life. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Extracorporeal photopheresis (ECP) seems to reduce the rate of lung function decline in transplant recipients with progressive BOS. METHODS: From 1991 until now, 239 LTs were performed at our center. Fifty-four patients (22.5%) developed BOS; 15 of these (27.7%) were treated with ECP. At the beginning of the treatment, all patients showed a mean decline of forced expiratory volume in 1 second (FEV1) from baseline values of 45.8% ± 17.2%; 2 patients were in long-term oxygen therapy. RESULTS: Mean follow-up from November 2013 to June 2016 was 11.6 ± 7 months. Twelve patients (80%) showed lung function stabilization with an FEV1 range after treatment between -6% to +8% from the pre-treatment values. We did not report any adverse effects or increase of infections incidence. DISCUSSION: ECP seems to be an effective and well-tolerated therapeutic option for LT patients with BOS in terms of stabilization of lung function and increased survival.

Is mechanical bowel preparation necessary in patients undergoing cystectomy and urinary diversion?

OBJECTIVE: To compare the surgical outcome in patients with or with no bowel preparation before cystectomy and ileal conduit urinary diversion, specifically assessing local and systemic complications. PATIENTS AND METHODS: All patients undergoing cystectomy and ileal conduit urinary diversion between January 1991 and December 1999 were assessed retrospectively. Twenty-two receive no bowel preparation (group 1) and were compared with 64 who had (group 2). Patients had similar demographic characteristics, stage and grade of tumour. Patients in group 2 received a standard 4-day bowel preparation and group 1 received no lavage or enemas. All patients underwent a standard iliac and obturator lymph node dissection, and cystoprostatectomy or anterior exenteration and ileal conduit urinary diversion. All patients received intraoperative metronidazole and gentamicin intravenously, and two further doses after surgery. RESULTS: Deaths after surgery were comparable in the two groups (two in group 1 and four in group 2) and the incidence of wound infection was similar (three and seven, respectively). There were no significant differences between the respective groups for fistula and anastomotic dehiscence (two and six) or sepsis (three and six). Group 2 had a higher incidence of wound dehiscence (one) than in group 1 (none). The incidence of prolonged postoperative ileus was lower in group 1 (one vs 12), as was the length of hospital stay (31.6 days vs 22.8 days). CONCLUSIONS: Bowel preparation had no advantage for the surgical outcome but it increased the length of hospital stay.

Case study: melatonin in severe obesity.

Nocturnal serum melatonin was measured at half-hour intervals from 6:30 P.M. to 7 A.M. in two sisters, one severely obese 15-year-old and one somewhat overweight 12-year-old. Both, otherwise, were physically and psychiatrically healthy. In the severely obese sister, there was a significant increase in the serum melatonin mean level, a delayed phase-shift, and a delayed peak. Also, her overnight urine melatonin and its metabolite, 6-hydroxymelatonin sulfate, were significantly higher. Could there be a relationship between dysregulation of the pineal gland and severe obesity?

Nocturnal serum melatonin profile in major depression in children and adolescents.

BACKGROUND: In major depression, biological rhythm disturbances in sleep, appetite, and mood suggest dysregulation in neuroendocrine functions, possibly in the pineal gland. In this study, pineal gland function was examined by measuring nocturnal serum melatonin levels during both wakefulness and sleep in depressed children and adolescents. METHODS: Twenty-two youths aged 8 to 17 years primarily with major depression were compared with 19 controls. Blood samples were drawn every half hour from 6 PM to 7 AM. Nocturnal serum melatonin levels were measured by radioimmunoassay. RESULTS: The overall nocturnal serum melatonin profile from 6 PM to 7 AM was significantly higher (mean +/- SD, 0.18 +/- 0.14 nmol/L) in the depressed group than in the controls [mean +/- SD, 0.15 +/- 0.10 nmol/L, F(1,26) = 4.37, P < .05]. In dim light, when the subjects were awake, no difference existed between the 2 groups. After lights-out, from 10 PM to 7 AM, the melatonin profile rose in both groups; however, the depressed group had a significantly higher increase (mean +/- SD, 0.24 +/- 0.14 nmol/L) than the controls [mean +/- SD, 0.18 +/- 0.07 nmol/L, F(1,26) = 4.93, mean square error = 0.11, P = .04]. Post hoc analysis showed a significantly higher melatonin profile in depressed subjects without psychosis (n = 15) than in depressed subjects with psychosis (n = 7) or in the controls. CONCLUSIONS: Measuring the overall nocturnal serum melatonin profile during darkness may help to differentiate children and adolescents with major depression without psychosis from those with psychosis and from controls.

Investigation of the subtypes of alpha 1-adrenoceptor mediating contractions of rat aorta, vas deferens and spleen.

1. The subtypes of alpha 1-adrenoceptor mediating contractions to exogenous noradrenaline (NA) or phenylephrine in rat vas deferens, spleen and aorta, and mediating contractions to endogenous NA in rat vas deferens have been examined. 2. In rat vas deferens, the competitive antagonists prazosin, WB 4101, benoxathian and 5-methyl-urapidil inhibited contractions to NA with pA2 values of 9.26, 9.54, 9.02 and 8.43, respectively. The irreversible antagonist chloroethylclonidine (CEC) (100 microM) failed to affect contractions to NA. 3. In rat vas deferens in the presence of nifedipine (10 microM), contractions to NA were significantly attenuated and under these conditions, CEC (100 microM) significantly reduced the maximum response to NA. 4. In rat spleen, the competitive antagonists prazosin, WB 4101 and benoxathian inhibited contractions to phenylephrine with pA2 values of 9.56, 8.85 and 7.60, respectively, and 5-methyl-urapidil had a KB of 6.62. CEC (100 microM) significantly reduced the maximum contraction to phenylephrine. 5. In rat aorta, the competitive antagonists, prazosin, WB 4101, benoxathian and 5-methyl-urapidil inhibited contractions to NA with pA2 values of 9.45, 9.21, 8.55 and 8.12, respectively. CEC (100 microM) produced an approximately parallel shift in the potency of NA, without significantly reducing the maximum response. 6. In epididymal portions of rat vas deferens in the presence of nifedipine (10 microM), the isometric contraction to a single electrical pulse was significantly reduced by CEC (100 microM), and by the competitive antagonists prazosin, WB 4101, benoxathian and 5-methyl-urapidil at concentrations of 1 nM. 7. In prostatic portions of rat vas deferens, the alpha l-adrenoceptor agonist, amidephrine, produced concentration-dependent increases in the isometric contraction to a single electrical stimulus and the maximum increase in the evoked response produced by amidephrine was unaffected by CEC (100 microM).8. Contractions of rat vas deferens produced by NA (and amidephrine) are mediated predominantly by alpha lA-adrenoceptors as shown by the high potency of alpha lA-adrenoceptor selective antagonists and the lack of effect of CEC. A small CEC-sensitive response, particularly in epididymal portions, was revealed in the presence of nifedipine. Contractions of rat spleen are mediated by alpha lB-adrenoceptors since alpha 1A selective antagonists showed low potency and CEC significantly reduced the maximum contraction to phenylephrine. Contractions of rat aorta to NA are mediated by non-alpha lA, non-alpha lB-adrenoceptors, due to the high potency of the aMA-selective antagonists and sensitivity to CEC.9. The noradrenergic contraction of epididymal portions of rat vas deferens in the presence of nifedipine is CEC-sensitive, but the alpha 1 A-selective antagonists showed high potency, suggesting that this response is mediated by non-alpha lA, non-alpha 1B-adrenoceptors.10. In conclusion, at least three subtypes of functional alpha 1-adrenoceptors have been demonstrated in these studies.

Comorbidity of mental disorders in the post-mortem diagnosis of completed suicide in children and adolescents.

In a psychological autopsy of 21 children and adolescents aged 11-19 years who committed suicide as compared with a matched-pair control group, 95% of the suicide victims and 48% of the controls had at least one serious diagnosable mental disorder (P less than 0.02). The presence of two or more mental disorders (comorbidity) was the rule occurring in 81% of the suicide victims and 29% of the controls (P less than 0.001). Mood disorders such as major depression, major depression superimposed on dysthymic disorder and dysthymic disorder coexisted with either alcohol and drug abuse, conduct disorder or other mental disorders in 76% of the victims and 24% of the controls (P less than 0.025). The suicide victims experienced significantly more psychosocial stressors and the poorest level of adaptive functioning. This study suggests that suicide in children and adolescents very frequently is the outcome of serious psychiatric disorders, particularly when associated with drug and alcohol abuse.

Psychological autopsy of completed suicide in children and adolescents.

A psychological autopsy of 20 children and adolescents aged 12-19 years who had committed suicide and a matched-pair control group revealed that 85% of the victims and 18% of the control subjects had expressed suicidal ideation. A statistically significant number of the victims had a history of suicide threats (55%), suicide attempts (40%), drug or alcohol abuse (70%), antisocial behavior (70%), or inhibited personality (65%). Suicidal behavior of parents, relatives, or friends and a parental history of emotional problems and absence or abusiveness were also significant factors for the victims.

Exploratory psychotherapy in the treatment of psoriasis. Twelve hundred years ago.

Twelve hundred years ago, Jasaliq, a Persian physician, treated a patient who was suffering from psoriasis. Although psoriasis was not clearly differentiated from leprosy in the West until the 1840s, it was clinically described and differentiated as a separate entity in Persia in the eighth century AD. In this case history reported in one of the oldest Persian texts, Chahar Maqala, written in 1155 AD, the physician formulated a dynamic relationship between the outbreak of psoriasis in his patient and the existence of severe interpersonal conflicts. In treating his patient, he skillfully used therapeutic modalities that are now prevalent in exploratory and psychodynamic psychotherapy. The techniques of developing a therapeutic alliance, therapeutic confrontation, clarification, dynamic interpretation, and exploration of intrapsychic and interpersonal conflicts are in accord with our present concepts of exploratory and dynamic psychotherapy.

The development of an acute short-term inpatient child psychiatric setting: a pediatric-psychiatric model.

The authors describe the establishment of a unit for children that emphasizes the integration of the pediatric model of acute, short-term inpatient care with the psychological and developmental perspective of the psychiatric model. Of the 145 children admitted during the first year, more than 33% manifested aggressive or hyperactive behavior and 25%, depression or suicidal behavior. Eighty-five percent were discharged to their homes or previous residences after an average length of stay of 24 days. The authors suggest that similar units established in children's hospitals or general hospitals could help meet the urgent need for acute inpatient psychiatric care of children in this country.

Gilles de la Tourette syndrome: a 20-month study of the effects of stressful life events and haloperidol on symptom frequency.

The frequency of tics in a 10-year-old boy suffering from Gilles de la Tourette syndrome was investigated in the laboratory and at home using counts of tics made by the parents. The study spanned 20 months during which time the patient was treated with haloperidol. Parents' counts were reliable and valid. Stressful life events overcame positive medication effects, and symptom level varied markedly with the activities in which the child engaged. Such situational variability may explain the previously reported waxing and waning of symptoms. Findings also suggested that specific counseling be given when haloperidol is prescribed in order to prepare parents and patients for any apparent worsening of the disorder that may actually be due to the presence of stressful life events.