[Ketamine Augmented Psychotherapy (KAP) in mood disorder: User guide]. / Psychothérapie augmentée par la kétamine (KAP) dans les troubles de l'humeur : mode d'emploi.

Ketamine, a non-competitive NMDA receptor antagonist, is used as a fast-acting antidepressant therapy in depressive disorders. This treatment provokes dissociative effects associating derealization and depersonalization, and a synaptogenic signaling cascade promoting brain plasticity. Despite several preliminary studies suggesting the usefulness of its combination with psychotherapy, administration of ketamine isn't generally combined with per- and post-infusion psychotherapy protocols in its clinical antidepressant use. However, the phenomenology of psychodysleptic experiences and the synaptogenic effect could potentiate cognitive and behavioral therapies (CBT). In this article, we purpose a practical protocol to Ketamine Augmented Psychotherapy (KAP) synthesizing contemporary data from the literature and our clinical experience. We detail proposals for clinical practice, and propose four important steps for the use of a psychodysleptic molecule for antidepressant purposes: preparation, administration, integration, and prolongation. Finally, we discuss the limits and prospects of this combination in the management of mood disorders.

[Ketamine, psilocybin, and rapid acting antidepressant: new promise for psychiatry?] / Kétamine, psilocybine, et antidépresseurs d'action rapide : de nouvelles promesses pour la psychiatrie?

The hypothesis of monoaminergic deficiency has long dominated the conceptual framework for the development of new antidepressant strategies, but the limits of conventional antidepressant treatments targeting monoaminergic signaling have motivated the search for new antidepressant pathways. The success of ketamine in the management of depressive disorders has provoked a renewed interest in hallucinogenic substances such as psilocybin targeting the serotonergic signaling 5HT2A and neurosteroid allosteric modulator of γ-aminobutyric acid (GABAA) receptors such as brexanolone. Unlike conventional treatments, these modulators of glutamatergic, serotonergic and GABAergic systems exert a rapid antidepressant effect ranging from 24hours to a week. Apart from their clinical interest and the fantasized search for a "miracle" molecule that jointly meets the expectations of patients and clinicians, these new targets could lead to the identification of potential new biomarkers for the development of rapid-acting antidepressants and redefine therapeutic strategies in mood disorders.

[What do virtual reality tools bring to child and adolescent psychiatry?] / Qu'apportent les outils de réalité virtuelle en psychiatrie de l'enfant et l'adolescent ?

Virtual reality is a relatively new technology that enables individuals to immerse themselves in a virtual world. It offers several advantages including a more realistic, lifelike environment that may allow subjects to "forget" they are being assessed, allow a better participation and an increased generalization of learning. Moreover, the virtual reality system can provide multimodal stimuli, such as visual and auditory stimuli, and can also be used to evaluate the patient's multimodal integration and to aid rehabilitation of cognitive abilities. The use of virtual reality to treat various psychiatric disorders in adults (phobic anxiety disorders, post-traumatic stress disorder, eating disorders, addictions…) and its efficacy is supported by numerous studies. Similar research for children and adolescents is lagging behind. This may be particularly beneficial to children who often show great interest and considerable success on computer, console or videogame tasks. This article will expose the main studies that have used virtual reality with children and adolescents suffering from psychiatric disorders. The use of virtual reality to treat anxiety disorders in adults is gaining popularity and its efficacy is supported by various studies. Most of the studies attest to the significant efficacy of the virtual reality exposure therapy (or in virtuo exposure). In children, studies have covered arachnophobia social anxiety and school refusal phobia. Despite the limited number of studies, results are very encouraging for treatment in anxiety disorders. Several studies have reported the clinical use of virtual reality technology for children and adolescents with autistic spectrum disorders (ASD). Extensive research has proven the efficiency of technologies as support tools for therapy. Researches are found to be focused on communication and on learning and social imitation skills. Virtual reality is also well accepted by subjects with ASD. The virtual environment offers the opportunity to administer controlled tasks such as the typical neuropsychological tools, but in an environment much more like a standard classroom. The virtual reality classroom offers several advantages compared to classical tools such as more realistic and lifelike environment but also records various measures in standardized conditions. Most of the studies using a virtual classroom have found that children with Attention Deficit/Hyperactivity Disorder make significantly fewer correct hits and more commission errors compared with controls. The virtual classroom has proven to be a good clinical tool for evaluation of attention in ADHD. For eating disorders, cognitive behavioural therapy (CBT) program enhanced by a body image specific component using virtual reality techniques was shown to be more efficient than cognitive behavioural therapy alone. The body image-specific component using virtual reality techniques boots efficiency and accelerates the CBT change process for eating disorders. Virtual reality is a relatively new technology and its application in child and adolescent psychiatry is recent. However, this technique is still in its infancy and much work is needed including controlled trials before it can be introduced in routine clinical use. Virtual reality interventions should also investigate how newly acquired skills are transferred to the real world. At present virtual reality can be considered a useful tool in evaluation and treatment for child and adolescent disorders.

Comparison of meat quality parameters in surgical castrated versus vaccinated against gonadotrophin-releasing factor male and female Iberian pigs reared in free-ranging conditions.

This study compared carcass and meat quality traits between 16 vaccinated (VF), 19 castrated (CF) and 8 entire (EF) female Iberian pigs, and between 21 vaccinated (VM) and 19 castrated (CM) male Iberian pigs reared in free ranging conditions. Vaccination consisted in the application of Improvac® at the age of 11, 12 and 14 months in VF and VM. Pigs were slaughtered at 16 months. In females, carcass and meat quality were found to be very similar regardless of the treatment. In males, VM had a leaner carcass, lower (P < 0.05) percentage of intramuscular fat, higher shear force and more rancidity than CM(P < 0.05 in all cases). It could be concluded that vaccination or suitable for free-range conditions in terms of product qualities. Vaccination in females did not alter carcass and meat quality, and specific interests should consider reproductive behavior in free-range conditions.

PRKAG3 and CAST genetic polymorphisms and quality traits of dry-cured hams--I. Associations in Spanish dry-cured ham Jamón Serrano.

The functional single polymorphisms identified in the calpastatin (CAST) gene have been related to the rate of meat tenderization and the protein turnover after slaughter, and the Ile199Val polymorphism identified in the coding region of the protein kinase AMP-activated (PRKAG3) gene has been proven to affect ultimate pH in muscle. The aim of the present study was to show the effects of these genetic polymorphisms on the quality traits of Spanish dry-cured ham Jamón Serrano. A tissue sample from 665 crossbreed pigs were genotyped for PRKAG3 Ile199Val, CAST Arg249Lys and CAST Ser638Arg polymorphisms, and a subsample of 120 dry cured hams was selected to perform physico-chemical, rheological, instrumental colour and sensory analyses. Associations between the polymorphisms and several quality traits of dry-cured ham, mainly related to flavour and texture, were found. The genotypes PRKAG3 Ile/Ile, CAST249 Arg/Arg and CAST638 Arg/Arg, and the haplotype CAST 249Arg-638Arg were the most favourable for Jamón Serrano production.

Beliefs and attitudes of butchers and consumers towards dry-cured ham.

The objectives were to evaluate the attitude of butcher and consumer towards soft and pasty texture problems in dry-cured ham and to assess the butcher and consumer behaviour when selecting and purchasing this product. Ninety-nine butchers and 200 consumers were interviewed with 17-question and 20-question surveys, respectively. The texture problems (softness and pastiness) were highly important for both butchers and consumers. The characteristics most frequently considered "important" or "very important" by butchers were processing time, smell/aroma and texture as selection criteria and salty taste and aged/matured flavour as sensory indicators of dry-cured ham quality. According to butchers' opinion, salty taste and their own advice are the factors most frequently considered "important" or "very important" as affecting the consumer's decision to purchase. For the consumer, the sensory attributes were considered more important than extrinsic characteristics when purchasing dry-cured ham.

The female inferior hypogastric (= pelvic) plexus: anatomical and radiological description of the plexus and its afferences--applications to pelvic surgery.

AIM OF THE STUDY: We wanted to determine the anatomical features of the inferior hypogastric plexus (IHP), and the useful landmarks for a safe surgical approach during pelvic surgery. MATERIALS AND METHODS: We dissected the IHP in 22 formolized female anatomical subjects, none of which bore any stigmata of subumbilical surgery. RESULTS: The inferior hypogastric plexus (IHP) is a triangle with a posterior base and an anterior inferior top. It can be described as having three edges and three angles; its inferior edge stretches constantly from the fourth sacral root to the ureter's point of entry into the posterior layer of the broad ligament; its cranial edge is strictly parallel to the posterior edge of the hypogastric artery, along which it runs at a distance of 10 mm; its posterior (dorsal) edge is at the point of contact with the sacral roots, from which it receives its afferences. They most frequently originate from S3 or S4 (60%) and then, in one or two branches, often from S2 (40%), never from S1 and in exceptional cases from S5 (20%). There are sympathetic afferences in 30% of cases, usually through a single branch of the second, third or fourth sacral ganglion. All IHPs have at least one sacral afference and sometimes there may be up to three afferences from the same sacral root. Its dorsal cranial angle, which is superior, comes after the SHP (hypogastric nerve or presacral nerve filament); its anterior inferior angle is located exactly at the ureter's point of entry into the posterior layer of the broad ligament. This is the top of the IHP; its posterior inferior angle is located at the point of contact with the fourth sacral root. At its entrance at the base of the parametrium the pelvic ureter is the anterior, fundamental positional reference for the IHP. The vaginal efferences come out of the top of the IHP through branches leading to the bladder, the vagina and the rectum, which originate through two trunks exactly underneath the crossing point of the ureter and the uterine artery: (i) one trunk leading to the bladder runs along and underneath the ureter and divides into two groups, which are lateral and medial, trigonal. (ii) the trunk leading to the vagina runs along the inferior edge of the uterine artery. At the point of contact with the lateral edge of the vagina, it splits into two groups: anterior thin and posterior voluminous. Some of its branches perforate the posterior wall of the vagina and are distributed to the rectovaginal septum in a tooth comb pattern. The inferior branches, which emerge from the inferior edge of the IHP, reach the rectum directly. The dissection of the 22 specimens allowed us to describe three efferent plexuses: a vaginal rectal plexus, a vesical plexus and a inferior rectal plexus. So the IHP's anterior, fundamental positional reference is the pelvic ureter at the point where it enters at the base of the parametrium, then at the crossing point of the uterine artery. The ureter is the vector for vesical efferences, the uterine artery is the vector for vaginal efferences, which are thus sent into the vesicovaginal septum and the rectovaginal septum. This surgical point of reference is of vital importance in nerve sparing during the course of a simple or extended hysterectomy. Any dissection carried out underneath and outside of the ureter inevitably carries a risk of lesions to its efferent, lateral vesical or medial, rectovaginal fibres.

[Poisoning caused by organophosphate insecticides. Study of 506 cases]. / Intoxicaciones por insecticidas organofosforados. Estudio de 506 casos.

A total of 506 cases of acute poisoning with organophosphorus insecticides attended at Hospital Torrecárdenas, Almería, from 1981 to 1992 were prospectively studied. In all cases a predetermined clinical and therapeutical protocol was followed. Eighty per cent of poisoning events were accidental in nature, most occurred in males, greenhouse workers, and the toxic agents was most commonly absorbed through the skin and airways. All patients presented initially with overt cholinergic symptoms. The presence of bronchorrhea, tremor-fasciculations, respiratory depression and a lower level of consciousness was associated with severe poisonings. Uncommon and exceptional complications included: 5 cases with complete atrio-ventricular block, 3 cases with pancreatitis, 17 cases with endogenous re-intoxications and 3 patients with central diabetes insipidus.

[Computerized EEG and personality]. / EEG computorizado y personalidad.

The ordinary EEG, on only showing qualitative malfunction of abnormal graphoelements in the tracings, proves itself insufficient to go into the analysis of psychological and psycho-pathological problems. Since computerised studies of EEG permit quantitative comparisons, we tried to apply them in correlation with the characteristics of the personality classified also with quantitative criteria, such as those offered in the personality inventory 16 PF; from which have been chosen the so-called factors of the second order, and the subjectivity-objectivity factors. The test was carried out on 100 voluntary subjects from Almeria (Spain), all with High School grades, between 18 and 40 years of age, of both sexes, all right-handed, without neuro-psychiatric history, and with normal ordinary EEGs. From the statistical analysis of the results one could deduce that there are significant specific relationships from the computerised EEG, with those secondary polar values of 16 PF: high and low anxiety, extroversion-introversion. Subjects with low anxiety presented a significant increase of the alpha band opposed to the subjects with high anxiety. There is a significant differences in power of the frontal areas between extrovert and introvert subjects. The extroverted subjects have a greater power of the right side and the introverted subjects a greater power of the left.

Tumor maligno de celulas de Sertoli (androblastoma maligno). / Malignant Sertoli cell tumor (malignant androblastoma)

Los tumores de celulas de Sertoli son escasos en el hombre (no mas de 70 descriptos), y su evolucion es habitualmente benigna. El diagnostico es a veces claro: tubos o esbozos de tubos revestidos por celulas alargadas de tipo Sertoli, pero otras veces no lo es tanto, al observarse entemezcladas en diferente proporcion celulas de tipo de granulosa del ovario, de Leydig testiculares, del blastema testicular mesenquimatoso, y tambien tubulos parecidos a tubos seminiferos puberales. Se acompanan de ginecomastina en 1/3 de los casos. Se relata el caso de un hombre de 57 anos portador de un tumor maligno de celulas de Seroli, con evolucion de 15 semanas entre la orquiepididectomia y el fallecimiento, con aparicion de metastasis pulmonares a las 6 semanas de operado. No existieron manifestaciones endocrinas. La rareza de estos tumores (10 en la literatura) impide formular un esquema terapeutico definido; su diferente modo evolutivo aun existiendo metastasis (rapido en algunos casos, lento en otros), impide tambien sentar un pronostico de evolucion a corto plazo

Tumor maligno de celulas de Sertoli (androblastoma maligno). / Malignant Sertoli cell tumor (malignant androblastoma)

Los tumores de celulas de Sertoli son escasos en el hombre (no mas de 70 descriptos), y su evolucion es habitualmente benigna. El diagnostico es a veces claro: tubos o esbozos de tubos revestidos por celulas alargadas de tipo Sertoli, pero otras veces no lo es tanto, al observarse entemezcladas en diferente proporcion celulas de tipo de granulosa del ovario, de Leydig testiculares, del blastema testicular mesenquimatoso, y tambien tubulos parecidos a tubos seminiferos puberales. Se acompanan de ginecomastina en 1/3 de los casos. Se relata el caso de un hombre de 57 anos portador de un tumor maligno de celulas de Seroli, con evolucion de 15 semanas entre la orquiepididectomia y el fallecimiento, con aparicion de metastasis pulmonares a las 6 semanas de operado. No existieron manifestaciones endocrinas. La rareza de estos tumores (10 en la literatura) impide formular un esquema terapeutico definido; su diferente modo evolutivo aun existiendo metastasis (rapido en algunos casos, lento en otros), impide tambien sentar un pronostico de evolucion a corto plazo