Awareness of the offense and perception of the victim among juvenile sex offenders.

INTRODUCTION: The present work presents data on research into adolescents who committed sex offenses, carried out in the Apulia Region of southern Italy and focused in particular on the perpetrators' perception of the peculiar profile of the criminal act committed. MATERIALS AND METHODS: Three University sections of the School of Medicine, Bari University, took part in this research: Criminology and Forensic Psychopathology, Psychiatry and Juvenile Neuropsichiatry, working in collaboration with the Department for Juvenile Justice and the Community, and the Center for Juvenile Justice in Apulia. In total, 31 subjects were included in the study, all Juvenile Sex Offenders. A detailed questionnaire was employed to obtain all the relevant information of criminological concern. DISCUSSION: Among most of the minors considered, a very poor awareness emerged of the peculiar type of offense committed, and of its consequences on the victims and the social context. RESULTS: This finding highlights an evident contradiction and confusion between legislative provisions in the area of sex offenses and rape, and the perspectives of juveniles and adolescents. CONSLUSIONS: There is an evident need for legislative norms to adopt registers that are more accessible to the complex juvenile world, that cannot be assimilated to the adult world.

[Judicial psychiatric hospital closings. Workers' expectations in rehabilitation facilities: A pilot study from the Province of Taranto (Italy)]. / Verso la chiusura degli Ospedali Psichiatrici Giudiziari.Aspettative degli operatori delle strutture riabilitative: unaricerca pilota nella Provincia di Taranto (Italia).

SCOPE: The aim of this study is to gain a clear understanding of the level of knowledge and training of staff members from psychiatric rehabilitation services in the Province of Taranto (Italy), where patients released from judicial psychiatric hospitals will be admitted. MATERIALS AND METHODS: A questionnaire taken from an earlier study on judicial psychiatric hospitals, conducted by The Ministry of Justice of the Department Penitentiary Administration - Superior Institute of Penitentiary Studies, was used in this study. Were contacted in advance of Directors 8 Community Rehabilitation and Psychiatric Care and Day Care Centres 7 present the province of Taranto, who has sought membership survey. RESULTS: Many requests for information and training regarding the problems and challenges related to the management of individuals who are mentally ill, perpetrators of crimes, and persons who are held in protective custody are made by those who work in these institutions. CONCLUSIONS: Hospital workers are highly apprehensive with regard to working with a patient population quite different from that which they are normally accustomed to. In order to confront these challenges, they, together with other colleagues from both the private and public services sector, have turned toward the concept of teamwork. One element of contradiction seems to be a low level of knowledge regarding what will be required of them when their work will be connected to the world of criminal justice in the future. The workers who were interviewed who have experience in working with patients from Judicial Psychiatric Hospitals seem to be up to the task of meeting the complex needs of the mentally ill and perpetrators of crimes within psychiatric rehabilitation facilities, as these patients must be kept under security.

Schizophrenia: a study comparing a family therapy group following a paradoxical model plus psychodrugs and a group treated by the conventional clinical approach.

A 'short family therapy' in schizophrenia, according to a specific systemic model (the 'Elementary Pragmatic Model' or EPM) with a strong paradoxical structure is presented. A total of 38 schizophrenic patients, randomly allocated, were treated according to the EPM model combined with psychotropic drugs (19 cases, each of whom underwent 10 weekly sessions of family therapy) or a traditional clinical-pharmacological approach (19 cases). With regard to all measures (number of drop-outs, symptoms according to the Brief Psychiatric Rating Scale, social activity according to the Strauss-Carpenter Outcome Scale and an interactive test) the EPM group showed better results. It is suggested that the systemic approach could be used not only as an effective therapy model in schizophrenia but also as an intervention in addition to or integrated into an ongoing psychoeducational family therapy.

Unilocular hydatid liver cysts: treatment with US-guided, double percutaneous aspiration and alcohol injection.

Sixteen hydatid liver cysts in 14 patients were treated with a percutaneous double puncture-aspiration-injection (D-PAI) technique with alcohol used as the scolecidal agent. With ultrasound guidance, fine-needle drainage of cysts was performed, and 95% sterile alcohol was injected and left in situ to partly refill the cystic cavities. The same procedure, without reaspiration of the injected alcohol, was performed 3 days later. Viability of scoleces was assessed at each aspiration. Benzoimidazolic drugs were administered 1 week before and 3 weeks after the procedure, to reduce the risk of seeding scoleces. Follow-up ranged from 8 to 28 months (mean, 14 months). Six cysts disappeared within 40-75 days of completion of D-PAI. In the other patients, smaller liquid areas or hypo- or hyperechoic solid masses were observed. Anaphylactoid reactions did not occur. In one patient, a biliary fistula developed after the first aspiration; the second ethanol injection was postponed until 6 months later but was effective. Viable scoleces were found at the second aspiration in only two patients whose hepatic liver cysts completely healed. Serologic titers substantially decreased in seven cases and became negative in two.

Methods for evaluating normal and pathological couples and families according to the elementary pragmatic model.

Following the interactional view of the problem of human communication and relation, as developed by many authors in past years, a review of the research in the field of the relational test is briefly described. In particular, an interaction test which permits automatic data collection and processing is designed, which derives from the Elementary Pragmatic Model by De Giacomo et al. A low cost minicomputer system is an adequate support, being the implemented procedures self consistent ones.

[Percutaneous therapy of hydatid cyst of the liver with ultrasound-guided double puncture-aspiration and alcoholization]. / Trattamento percutaneo delle cisti idatidee del fegato con doppia puntura-aspirazione ed alcolizzazione ecoguidata.

Fourteen patients (9 females, 5 males; age range: 22-80 years) with 16 univesiculated hydatid cysts of the liver (O ranging 4.2-14 cm) underwent two sessions of puncture-aspiration-alcohol injection (D-PAI) under real-time US guidance at 3-day intervals. Two patients had postoperative recurrences. One patient was pregnant (9 weeks' gestation): her cyst doubled its volume over 2 months. One patient had HBV chronic hepatitis treated by means of interferon: also in this case the cyst doubled its volume. The remaining were high-risk patients for surgery or had refused operation. At US follow-up (ranging 4-24 months) 6 cysts exhibited complete reconstitution of liver parenchyma. In the extant patients two different US patterns were observed: 1) liquid areas with detached inner membranes (4 cysts); 2) solid inhomogeneous areas (6 cysts). In these cases the volume was reduced by 50-80%. No allergic complication occurred either during or after the procedure. Two patients only were affected with vomiting and fever, which resolved in a few hours. Our results indicate D-PAI of univesiculated hydatid cysts of the liver to be an effective alternative to surgery.

A technique to simulate human interaction: relational styles leading to a schizophrenic communication pattern and back to normal.

This article describes an attempt to use a theoretical model of human interaction called the elementary pragmatic model to determine which communication style leads from a normal subject's interactive pattern to a schizophrenic's and, conversely, from schizophrenia to normality. Results of this experimentation reveal a clear correspondence with the data published in the literature on communication deviances and family therapy. The computer simulation indicates preferential ways of therapeutic intervention.

Morphologic and motility changes of the gallbladder in response to acute liver injury. A prospective real-time sonographic study in 255 patients with acute viral hepatitis.

In 255 patients with acute viral hepatitis and in 50 healthy controls, wall thickness, volume, and percentage of maximal contraction of the gallbladder were prospectively evaluated using real-time ultrasonography. A hypotonic, hypokinetic gallbladder was shown in 58.4% of the cases, expressed by normal parietal thickness, larger volume, and lower response to fat stimulation than the controls. In the remaining patients, wall thickening, decreased volume, and reduced contraction were compatible with a hypertonic gallbladder. Because the latter pattern was never observed in patients with disease onset dating back more than 9 days, it is conceivable that gallbladder hypertonicity in the early phase of the illness is followed by depression of tone and motor activity. However, such sonographic features turned out to be short-lived and reversible as they disappeared in all patients within 3 weeks of the first ultrasound examination. Moreover, none of the sonographic abnormalities correlated with either biochemical indices of acute disease or the patients' long-term outcomes.

Ultrasonically-guided percutaneous transcholecystic cholangiography--an alternative approach in cases of biliary obstruction and failure of percutaneous transhepatic cholangiography.

Fourteen ultrasonically-guided percutaneous transcholecystic cholangiographies (PTCC) were performed in subjects with biliary obstruction with different underlying diseases. No complication was observed, and the procedure permitted diagnosis in all cases, although the previously reported difficulty of visualizing proximal bile ducts was confirmed in two cases. PTCC can constitute a valid and safe diagnostic alternative in obstructive jaundice in which no dilation of intrahepatic bile ducts is revealed on US, in cases in which percutaneous trans-hepatic cholangiography fails.

[Clinical significance of hyperechogenic focal lesions of the cirrhotic liver]. / Significato clinico delle lesioni focali iperecogene nel fegato cirrotico.

A review was made of the ultrasonographic (US) examinations performed over the period 1981-1986; 27 cirrhotic patients with hyperechoic liver lesions were identified, whose diagnoses had been made by means of either US-guided percutaneous biopsy, or laparoscopy, or autopsy. In 24 patients hepatocellular carcinomas nodules (HCC) were found, associated with cirrhosis, while in 3 cases only cirrhosis was seen. In the above mentioned 3 cases, a 2-year US follow-up showed no variation in the size of the nodules. These data confirm the importance of US in the screening of risk HCC patients, and point out that--however small--hyperechoic lesions in a cirrhotic liver suggest the cancerization of the substanding cirrhosis.

Survey of delta infection in the Naples basin: a possible epidemiologic model for endemic areas.

The prevalences of delta co-infections and superinfections in 100 randomly selected subjects for each year from 1977 to 1982 and in all the subjects of subsequent years until April 1986, admitted to our Department with acute viral hepatitis B (AVHB), were evaluated and compared with the annual incidence of cases of AVHB reported in Naples during the same period. Moreover, anti-delta antibodies were determined in the sera of 25 consecutive cases of HBsAg-positive chronic active hepatitis and 25 consecutive cases of HBsAg-positive chronic active hepatitis and 25 consecutive cases of HBsAg-positive cirrhosis, respectively, for 1977, 1980, 1983 and 1986. Our data show a high, constant circulation of HDV and a decrease in its incidence in acute forms over the last 3 years, which coincides with the parallel lower incidence of AVHB, but which is not reflected in the delta prevalence in the chronic forms. They also indicate the possible existence of alternate cycles of increase and decrease in the infection, partly dissociated from HBV circulation, which present peculiar epidemiologic characteristics.

Research on the effects of psychodrugs on human interaction. A theoretical/experimental approach.

An original method of testing which can measure interactional patterns is presented. This method is based on a relational model, which describes the relational behaviour as a sequence of elementary interactions, in which a "single bit of information" is exchanged. The model and the testing method are applied to monitoring treatment of patients with psychodrugs.

Ultrasound evaluation of uncomplicated and complicated acute viral hepatitis.

Seven hundred ninety-one consecutive patients with acute viral hepatitis, 17 of whom had liver failure, and 97 healthy volunteers were examined by ultrasound. No specific patterns were found in either the uncomplicated or the complicated forms. Only 19 subjects showed a typical "bright liver" pattern, which is correlated with significant vacuolar hepatocellular degeneration. The increased brightness and clear visualization of portal vein radicle walls, previously described in this disease, were detected in only 32.2% of the hepatitis patients but were also seen in 30.9% of the normal controls.