Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial.

OBJECTIVE: This study presents data from a randomized outcome study comparing mentalization-based and supportive psychotherapy for patients with borderline personality disorder (BPD). METHOD: Eighty-five SCID-II diagnosed borderline patients were randomized to either i) 2 years of intensive (twice weekly) combined (individual and group), mentalization-based psychotherapy (MBT) or ii) 2 years of less-intensive (biweekly) supportive group therapy. Treatment outcome was assessed using a battery of self-report questionnaires, SCID-II interviews and therapist-rated global assessment of functioning (GAF). RESULTS: Fifty-eight patients completed 2 years of treatment. Significant changes in both treatment groups were identified for several outcome measures, including self-reported measures of general functioning, depression, social functioning and number of diagnostic criteria met for BPD, as outlined by the SCID-II interview. General linear modelling was used to compare treatment outcome in the two groups. Only GAF showed a significantly higher outcome in the MBT group. A trend was found for a higher rate of recovery from BPD in the MBT group. Pre-post effect sizes were high (0.5-2.1) and for the most part highly significant in both groups. CONCLUSION: The study indicates that both MBT and supportive treatment are highly effective in treating BPD when conducted by a well-trained and experienced psychodynamic staff in a well-organized clinic.

Demonstration of polarization-independent resonant subwavelength grating filter arrays.

We demonstrate a two-dimensional (2D) polarization-independent resonant subwavelength grating (RSG) in a filter array. RSGs, also called guided mode resonant filters, are traditionally one-dimensional gratings; however, this leads to TE and TM resonances at different wavelengths and with different spectral shape. A 2D grating can remove the polarization dependence at normal incidence, while maintaining the desirable RSG properties of high reflectivity, narrow passband, and low sidebands without ripple. We designed and fabricated 2D gratings with near-identical responses for both polarizations at normal incidence in the telecommunication band. Ninety percent reflectivity is achieved at the resonant wavelengths.

Pancreatic pseudocyst located in the liver.

Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Extrapancreatic locations of pancreatic pseudocyst in the liver, pleura, mediastinum, or pelvis have been described. However, a pancreatic pseudocyst located in the liver is an infrequent condition. We present the case of a 46-year-old man with pancreatic pseudocyst located in the liver secondary to chronic alcoholic pancreatitis. During admission, the patient underwent an abdominal CT scan that showed a mass located in the head and body of the pancreas, as well as a thrombosis of the splenic vein. A percutaneous needle aspiration biopsy of the pancreas was obtained under CT guidance, which showed no tumoral involvement. Fourty-eight hours after the procedure the patient developed abdominal pain and elevated serum amylase levels. A pancreatic MRI exam showed two pancreatic pseudocysts, one of them located in the left hepatic lobe, the other in the pancreatic tail. Chronic pancreatitis signs also were found. Enteral nutrition via a nasojejunal tube was administered for two weeks. The disappearance of the pancreatic pseudocyst located in the pancreatic tail, and a subtotal resolution of the pancreatic pseudocyst located in the liver were observed. To date twenty-seven cases of pancreatic pseudocyst located in the liver have been published, most of them managed with percutaneous or surgical drainage.

Biological Properties of Apple Scar Skin Viroid: Isolates, Host Range, Different Sensitivity of Apple Cultivars, Elimination, and Natural Transmission.

Studies conducted over the last 10 years have revealed that the disease caused by the apple scar skin viroid (ASSVd) is extremely rare in Europe. ASSVd was detected by molecular hybridization and indexing in field plots on the apple indicators Starkrimson and Indo, which showed symptoms of dapple apple disease within 2 years, and rough scarred skin within 3 years, respectively. Results from both approaches were in agreement. In an attempt to improve the biological detection of ASSVd, the Japanese PK13 isolate was inoculated to 4 Prunus, 13 Malus, 17 Pyrus, and 17 other pomaceous species. All the species tested of the Malus, Pyrus, Sorbus, Chaenomeles, Cydonia, and Pyronia genera were susceptible to ASSVd based upon back indexing and hybridization, but none developed leaf or bark symptoms during a 2-year period. The viroid was not detected in the tested members of genera Amelanchier, Aronia, Cotoneaster, Crataegus, Prunus, and Pyracantha. Symptoms on fruit of 42 commercial apple cultivars experimentally inoculated with ASSVd fell into five groups ranging from inconspicuous spots to severely scarred skin and cracking. ASSVd was eliminated from most of the infected apple plants when they were subjected to a dormant stage followed by thermotherapy and shoot tip grafting. Analysis of more than 400 apple seedlings, originated from Starkrimson and Indo fruits with typical ASSVd symptoms, showed that there is little or no seed transmission of this viroid. However, ASSVd was transmitted at a low rate under field conditions to adjacent trees.

Investigation of the effect of finite grating size on the performance of guided-mode resonance filters.

We evaluate the effect of finite aperture gratings on the spectral and efficiency characteristics of guided-mode resonance filters. A simple analytical model based on the attenuation properties of the waveguide and a fixed length of the grating aperture is developed. The results from this model are in good agreement with experimental filters formed with subwavelength period photoresist gratings and solgel waveguides.

Resonant waveguide-grating switching device with nonlinear optical material.

The design and analysis of a dielectric guided-mode resonance filter (GMRF) utilizing a nonlinear material for the waveguide is presented. Small changes to the parameters of a GMRF have a large impact on its resonance. A nonlinear material can provide a small change in the refractive index of the waveguide, altering the resonance of the device and resulting in modulation of the transmitted and reflected output of the filter. Numerical results show that nonlinear switching from 100% transmission to 100% reflection can be accomplished with less than 100 kW/cm(2) using a simple design.

Complications of orthotopic liver transplantation: spectrum of findings with helical CT.

Orthotopic liver transplantation has become the treatment of choice for patients with end-stage nonmalignant liver disease. The surgical techniques and immunosuppressive therapy for this procedure have improved considerably. Nevertheless, there are still significant complications, particularly those of vascular origin, which can lead to graft failure and require retransplantation unless prompt treatment is instituted. These complications include arterial and venous thrombosis and stenosis; arterial pseudoaneurysm; biliary leakage, stricture, and obstruction; liver ischemia, infarction, and abscess; fluid collections and hematomas; lymphoproliferative disorders; recurrent tumors; hepatitis C virus infection; and splenic infarction. Since the clinical presentation of posttransplantation complications is frequently nonspecific and varies widely, imaging studies are critical for early diagnosis. Helical computed tomography (CT) is a valuable complement to ultrasonography (US) in the postoperative period and is a safe, accurate, and noninvasive method of demonstrating hepatic vessels (hepatic artery, portal vein, hepatic veins, and inferior vena cava) and evaluating nonvascular complications (in the hepatic parenchyma and bile duct abnormalities) and extrahepatic tissues. Knowledge and early recognition of these complications is essential for graft salvage, and CT can provide valuable information, particularly for patients with indeterminate US results or in whom US examination is difficult.

Helical CT in renal transplantation: normal findings and early and late complications.

Over a 5-year period, 346 helical computed tomographic (CT) studies were performed in renal transplant recipients. Helical CT proved useful in this context by depicting parenchymal, perirenal, renal sinus, pyeloureteral, and vascular complications in great detail. CT often delineates fluid collections and their anatomic relationship to adjacent structures better than ultrasonography (US), particularly in obese patients. CT-guided puncture and drainage can be performed in cases in which US is deemed inadequate. CT angiography can depict arterial diseases such as stenosis, thrombosis, arteriovenous fistulas, aneurysms, and pseudoaneurysms in the graft artery and in the recipient iliac arterial system, thereby obviating conventional angiography in some cases. Helical CT with three-dimensional image reformatting allows accurate imaging of the entire course of ureteral and periureteral diseases (eg, hydronephrosis, ureteral leak and stricture, pyeloureteral obstruction). CT can be used in the confirmation and staging of malignancies of the renal parenchyma and urothelium. It is also helpful in evaluating associated disease in the native kidneys, acute and chronic rejection, graft embolization, and end-stage disease. Although US and nuclear medicine examination are the imaging modalities of choice in renal transplantation, helical CT is a valuable alternative when these techniques are inconclusive.

Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis.

Portomesenteric vein gas is a rare condition whose pathogenesis is not fully understood. Portomesenteric vein gas is most commonly caused by mesenteric ischemia but may have a variety of other causes. The primary factors that favor the development of this pathologic entity are intestinal wall alterations, bowel distention, and sepsis. Portomesenteric vein gas is idiopathic in approximately 15% of cases. Advanced imaging techniques such as computed tomography (CT) have increased the sensitivity for detection of portomesenteric vein gas. At CT, portal vein gas appears as tubular areas of decreased attenuation in the liver, predominantly in the left lobe. Gas in the great mesenteric veins can easily be demonstrated with contrast material-enhanced CT, whereas gas in the small mesenteric veins appears as tubular or branched areas of decreased attenuation in the mesenteric border of the bowel. Findings of portomesenteric vein gas at CT should be carefully evaluated in the context of clinical findings. In the majority of cases, the prognosis is favorable and surgery is not required. However, when CT demonstrates portomesenteric vein gas and clinical findings suggest the presence of mesenteric ischemia, surgery is mandatory.