Efficacy of once-daily clindamycin hydrochloride in the treatment of superficial bacterial pyoderma in dogs.

Twenty-one dogs with canine superficial bacterial pyoderma were treated with clindamycin at a dosage of approximately 11 mg/kg body weight, q 24 hours, given orally for 14 to 42 days. All dogs were reexamined on days 14, 28, and, if necessary, 42 and given a clinical score of excellent (i.e., complete remission), good (i.e., primary lesions resolved but secondary lesions evident), fair (i.e., partial improvement but primary lesions still evident), or poor (i.e., no improvement or worsening of the lesions). A clinical score of excellent was obtained in 71.4% (15/21) of the dogs in this study within 14 to 28 days.

Treating adolescent conversion disorders: are hypnotic techniques reusable?

When treating disabling conversion disorders in hospitalized adolescents, clinicians must act to restore function as rapidly as possible. After attempting to rule out physical causes for the symptoms and trying to find persuasive psychological reasons that the patient will accept and use to resolve the condition, the inpatient staff of a multidisciplinary therapeutic milieu must seek additional approaches to the care of these seriously ill individuals. This clinical forum reports the author's experience treating 2 young patients, a 12-year-old girl and a 15-year-old boy, with hypnosis. Therapists of every experience level find hypnotic techniques that work for them in a variety of patients, but are hypnotic techniques really reusable? The author reports what he learned once again.

Self-hypnosis training as an adjunctive treatment in the management of pain associated with sickle cell disease.

A cohort of patients with sickle cell disease, consisting of children, adolescents, and adults, who reported experiencing three or more episodes of vaso-occlusive pain the preceding year, were enrolled in a prospective two-period treatment protocol. Following a 4-month conventional treatment baseline phase, a supplemental cognitive-behavioral pain management program that centered on self-hypnosis was implemented over the next 18 months. Frequency of self-hypnosis group straining sessions began at once per week for the first 6 months, became biweekly for the next 6 months, and finally occurred once every third week for the remaining 6 months. Results indicate that the self-hypnosis intervention was associated with a significant reduction in pain days. Both the proportion of "bad sleep" nights and the use of pain medications also decreased significantly during the self-hypnosis treatment phase. However, participants continued to report disturbed sleep and to require medications on those days during which they did experience pain. Findings further suggest that the overall reduction in pain frequency was due to the elimination of less severe episodes of pain. Non-specific factors may have contributed to the efficacy of treatment. Nevertheless, the program clearly demonstrates that an adjunctive behavioral treatment for sickle cell pain, involving patient self-management and regular contact with a medical self-hypnosis team, can be beneficial in reducing recurrent, unpredictable episodes of pain in a patient population for whom few safe, cost-effective medical alternatives exist.

Psychosocial and immune effects of self-hypnosis training for stress management throughout the first semester of medical school.

This study was a 19-week prospective conducted to determine the effectiveness of a self-hypnosis/relaxation intervention to relieve symptoms of psychological distress and moderate immune system reactivity to examination stress in 35 first-year medical students. Twenty-one subjects were randomly selected for training in the use of self-hypnosis as a coping skill and were encouraged to practice regularly and to maintain daily diary records related to mood, sleep, physical symptoms, and frequency of relaxation practice. An additional 14 subjects received no explicit training in stress-reduction strategies, but completed similar daily diaries. Self-report psychosocial and symptom measures, as well as blood draws, were obtained at four time points: orientation, late semester, examination period, and postsemester recovery. It was found that significant increases in stress and fatigue occurred during the examination period, paralleled by increases in counts of B lymphocytes and activated T lymphocytes, PHA-induced and PWM-induced blastogenesis, and natural killer cell (NK) cytotoxicity. No immune decreases were observed. Subjects in the self-hypnosis condition reported significantly less distress and anxiety than their nonintervention counterparts, but the two groups did not differ with respect to immune function. Nevertheless, within the self-hypnosis group, the quality of the exercises (ie, relaxation ratings) predicted both the number of NK cells and NK activity. It was concluded that stress associated with academic demands affects immune function, but immune suppression is not inevitable. Practice of self-hypnosis reduces distress, without differential immune effects. However, individual responses to the self-hypnosis intervention appear to predict immune outcomes.

Clinical guidelines in using hypnosis in uncovering memories of sexual abuse: a master class commentary.

These clinical guidelines are suggested to enhance the safe practice of the psychotherapy of increasing numbers of patients seeking help in uncovering memories of sexual abuse. However, it is ultimately the clinician's own judgment with each patient/client that determines the best path to follow. When therapeutic impasse occurs, consideration of these guidelines will, it is hoped, be beneficial to both therapist and patient.

Loin pain hematuria syndrome.

LPHS is a disorder of obscure etiology and inconsistent pathology whose most prominent clinical feature is severe flank pain. Were it not for the hematuria which nearly always accompanies the pain, there would be no specific objective correlate of the syndrome. In this sense, it is similar to a number of chronic conditions which have inspired heated controversy about their very existence as discrete diseases. As the foregoing discussion of pathogenesis, pathology and diagnosis illustrates, with respect to two important characteristics of a 'prototypical' disease--specificity and mechanism--LPHS falls far short. This, coupled with a rather unimpressive 'visible' concomitant of the symptoms (hematuria), has inspired skepticism and even suspicion in some physicians confronted with the demands for analgesia by these patients. On the part of physicians who have been involved in the care of these patients over time, however, there is no doubt that they suffer from a bona fide illness, if not a disease. The severity of the illness is evinced by the rather extreme measures that have been taken in its treatment; e.g., surgical denervation of the kidney, nephrectomy, autotransplantation. Only the last of these appears to offer the hope of enduring pain relief while preserving renal function, but the risk of pain recurrence in the autograft may limit the usefulness of this procedure. Accordingly, narcotic analgesics may need to be the treatment of first and last resort. Development of specific treatment will depend upon elucidating the pathogenesis of the disorder. The available data suggest further investigation of the role of vasoactive mediators, and the coagulation and immune systems.