[Spontaneous hematoma and hip pain in a 65-year old patient]. / Spontane Hämatomneigung und Hüftschmerzen bei einer 65-jährigen Patientin.

The case of a 65-year-old woman with acquired hemophilia is reported. Acquired hemophilia is characterized by the development of inhibitors directed against coagulation factors. Impairment of plasmatic hemostasis leads to a severe bleeding tendency in individuals without a preexisting coagulation defect with considerable mortality. Pathophysiology, diagnostic work-up, and treatment are summarized and discussed.

Effect of anti-CD 20 antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD).

Post-transplant lymphoproliferative disorders (PTLD) are a life-threatening complication following solid organ transplantation. Treatment with rituximab, a humanized anti-CD20 monoclonal antibody, has proved to be a promising approach and shown a low toxicity profile. Between February 1999 and April 2002, we conducted a multicentre phase II trial investigating rituximab as single agent in 17 patients with PTLD. Transplanted organs were heart (n = 5), kidney (n = 4), lung (n = 4) and liver (n = 4). Patients were treated with four weekly doses of 375 mg/m(2) of rituximab. The mean follow-up time is 24.2 months. Histology was distributed in 10 diffuse large cell-, 2 marginal zone-, 1 Burkitt-like lymphoma, 1 Hodgkin-like PTLD and 3 polymorphic lymphoproliferations. Therapy was well tolerated and no severe adverse events were observed. The mean overall survival period is 37.0 months with 11 patients still living. In total, 9 patients (52.9%) achieved a complete remission, with a mean duration of 17.8 months. Partial remission was observed in 1 patient, minor remission in 2 patients, no change in 3 patients and 1 patient experienced progressive disease. Two patients relapsed, at intervals 3 and 5 months after obtaining complete remission. Rituximab proved to be well tolerated and effective in the treatment of PTLD.

Evaluation of intensive inpatient treatment of patients with severe personality disorders.

OBJECTIVE: The purpose of this study was to determine whether severe personality disorders improve or deteriorate with intensive inpatient treatment. METHODS: Overall 216 patients diagnosed as having personality disorders by DSM-III-R criteria were prospectively monitored at two private psychiatric hospitals from admission through discharge to one-year follow-up. RESULTS: Substantial positive change in the sample was recorded at discharge, and the improvements held up at one-year follow-up. The proportion of patients with scores of 50 or more on the Global Assessment Scale was 3.7 percent at the time of admission. By discharge the proportion had increased to 55.1 percent, and by one-year follow-up it had risen to 66.3 percent. CONCLUSIONS: These results suggest that patients with severe personality disorders benefit from intensive inpatient treatment. We found no evidence that hospitalization of such patients is associated with regression or deterioration of function.

Children of disaster in the second decade: a 17-year follow-up of Buffalo Creek survivors.

OBJECTIVE: To conduct a long-term follow-up of child survivors of a devastating human-caused disaster. METHOD: Child survivors (2-15) of the Buffalo Creek dam collapse, first evaluated in 1974, 2 years postdisaster, were reevaluated 17 years postdisaster when they were adults. Of the original 207 children, 99 were located and reevaluated using ratings on the Psychiatric Evaluation Form, the Impact of Event Scale, and the SCL-90 and lifetime and current diagnoses from the Structured Clinical Interview for DSM-III-R. RESULTS: Ratings of psychiatric symptoms at the two points in time showed significant decreases in overall severity ratings and in anxiety, belligerence, somatic concerns, and agitation. A few symptoms, not present in the child sample, increased over time (substance abuse, suicidal ideation). The current rate of disaster-related post-traumatic stress disorder (PTSD) was 7%, down from a postflood rate of 32%. There were no differences by age group in current psychological status; however, women evidenced more PTSD-related symptoms than did men. All current PTSD cases were women. Comparisons with similar subjects from a nonexposed community showed no differences. CONCLUSIONS: The findings indicated that the children studied, although having shown earlier effects, had "recovered" from the event by the time of long-term follow-up.

Children and disaster: age, gender, and parental effects on PTSD symptoms.

Psychiatric reports of 179 children aged 2 to 15 who were exposed to the Buffalo Creek dam collapse in 1972 were rated for post-traumatic stress disorder (PTSD) symptoms 2 years after the disaster. Age and gender effects and the impact of the level of exposure and parental functioning were examined according to a conceptual model addressing factors contributing to adaptation to a traumatic event. Results showed fewer PTSD symptoms in the youngest age group and higher symptom levels for girls than boys. Approximately 37% of the children were given a "probable" diagnosis of PTSD. Multiple regression analysis showed that life threat, gender, parental psychopathology, and an irritable and/or depressed family atmosphere all contributed to the prediction of PTSD symptomatology in the children.

[Smoking habit at school. First habit at school. First results of a survey done in Marseille and its suburbs (author's transl)]. / Le tabagisme scolaire. Premiers résultats d'une enquête réalisée dans l'agglomération marseillaise.

The authors report the first results of a transversal survey done from the end of November 1976 to the end of April 1977 in 4 secondary schools (CES, CEG) in Marseille and its suburbs. 1.795 children, between 11 and 15, in the first and fourth form, filled up a questionary inquiring into their smoking habits and consumption. Already a certain number of results can be drawn: --in this group of children, mostly girls (926 G/882 B) 181 were regular smokers (10,07%); --among these smokers, 70 smoked every day (38,6%), 60 smoked more than a packet a week (33%), finally 122 inhaled smoke; --they acquired the habit of smoking regularly between the age of 14 and 15, in the 3rd and 4th forms, as there was only 9,4% of smokers in the 3rd and 19% in the 4th form; --finally, parents seem to play a fundamental inducing part in this habit, as among smoking children 32.8% have parents both smoking, 41% a smoking mother, 71.2% a smoking father, while for non smokers the percentage were respectively of 19.9%, 24.9% and 54.3%.