[The by law required assessment by a child psychiatrist before cosmetic interventions; retrospective file research]. / Wettelijk verplicht kinderpsychiatrisch onderzoek voorafgaand aan een esthetische ingreep; retrospectief dossieronderzoek.

BACKGROUND: Surgical and non-surgical cosmetic interventions are on the rise, also in minors. Therefore, the society, healthcare system and government are searching for an ethical-medical-legal framework. Numerous studies have shown the importance of patient selection. The absence of psychopathology correlates with a good outcome of cosmetic interventions. Since July 2013, the law in Belgium requires a consultation with a child psychiatrist or child psychologist before minors are allowed to undergo cosmetic intervention.
AIM: To evaluate the clinical impact and effectiveness of this Belgian law.
METHOD: Retrospective research of all patient evaluations by an independent child psychiatrist in the context of this law at the University Hospital, Free University Brussels from 12/07/2013-12/07/2017. Descriptive analysis of following variables as mentioned in the report of the child psychiatrist: type of cosmetic intervention, socio-demographic data, psychosocial problems, (symptoms of) child psychiatric diagnoses, recommendations.
RESULTS: Thirty-seven patients consulted a child psychiatrist before a planned cosmetic intervention, 36 of them had an otoplasty and 1 a rhinoplasty. Twelve patients had symptoms of at least 2 psychiatric disorders for whom further examination was required. However, these did not constitute a contraindication for the cosmetic intervention. None of the patients had (symptoms of) a body dysmorphic disorder.
CONCLUSION: Mainly patients who underwent otoplasty and with an obvious deviation from appearance that caused suffering were evaluated at the University Hospital, Free University Brussels four years after implementation of the law on cosmetic interventions. No child psychiatric contraindications for the cosmetic intervention were found in this population. It seems more useful to nuance this legislation and ask more specific for advice from a child psychiatrist in patients with risk factors. The identification of patients with a possible (child) psychiatric disorder remains of utmost importance.

Carcinogenicity studies of astemizole in mice and rats.

The histamine H1 antagonist astemizole (Hismanal) was tested for carcinogenicity in Swiss mice and Wistar rats. Astemizole was administered with the food to mice for 18 and to rats for 24 consecutive months. The doses given--approximately 5, 20, and 80 mg/kg body weight.day--were equivalent to 25, 100, and 400 times, respectively, the recommended human dose of 10 mg/day. Survival of both mice and rats was comparable between groups. Peto's age-adjusted, dose-related trend analysis for the tumor-bearing rats did not reveal a statistically significant difference for males or females. There was no evidence that astemizole led to an increased incidence of spontaneously or unusually occurring neoplastic lesions in either mice or rats. Special attention was given to the effect of astemizole on the progression of spontaneously occurring mammary gland adenomas and fibroadenomas. Peto's analysis applied to the number of female rats bearing these benign mammary gland tumors disclosed no statistically significant dose-related trend. There was no positive trend for the onset of this tumor type, and the median size of the tumor over time per rat was also not statistically significantly different in a comparison of the control group with each of the dosed groups. The findings from these carcinogenicity studies suggest that astemizole is not tumorigenic and that it does not promote tumor growth.

Safety aspects of oral antifungal agents.

Four main targets have to be considered when evaluating the safety of new systemically acting, oral antifungals: the liver, the endocrine system, serum cholesterol and the developing embryo. The major endocrine targets for high levels of the antifungal azoles are the adrenal cortex and the gonads. Endocrine studies demonstrate that itraconazole has little potential for interfering with steroid hormones in man. Available data also indicate that itraconazole has low predictable hepatotoxicity potential in man. In rats, serum cholesterol levels are raised during treatment with itraconazole, especially after chronic exposure. This is, however, a species-specific phenomenon which leads to secondary events at toxic doses, especially in long-term toxicity studies. In man, including patients with existing hypercholesterolaemia, serum cholesterol levels are not raised. Ketoconazole has been shown to be teratogenic at high, toxic doses in pregnant rats. The same observation has been made for itraconazole, and it may also be true for fluconazole. However, all three azoles show no teratogenicity in the rabbit. Studies with itraconazole in adrenalectomised rats and in rats given exogenous arachidonic acid indicate that adrenal effects occurring at toxic dose levels are important mediators of teratogenicity. Since itraconazole does not affect adrenal function at levels used to treat infections in man, the teratogenic risk is estimated to be low. Itraconazole is therefore a promising new drug, especially with regard to the assessment of its safety in the liver and endocrine system. Moreover, it is more potent and has a broader antifungal spectrum than other azole antifungals, and its development is considered to be an important step forward in chemotherapy.

Adolescent and adult cystic fibrosis patients: how to leave home when you are depending on it?

Over a period of 1 year, 11 on 23 CF adolescent or adult patients were referred to the childpsychiatrist (CP) for psychological problems and a notice of total dependency of their parents. The approach of the CP was systematic and family oriented. We noticed that on 11 patients only 6 came to the appointment and only 6 on 10 parents accepted to contact the CP. Of the 6 studied cases 4 showed severe psychopathology (1 sexual abuse, 1 physical and emotional abuse, 2 extreme over-protection), 2 showed psychological problems due to their restricted life conditions. On top of this, all 6 met enormous financial and social problems to gain more independency. The dependency of CF adolescent and adult patients is a family problem and a combination of relational, emotional, but also practical and financial problems and thus not exclusively due to their illness. As the prognosis of cystic fibrosis (CF) improved significantly, every aspect of this disease also became an "adult" problem. Independency is only one aspect and can not be considered on its own. We have to look at all technical, psychological and social adjustment problems those patients and their parents have to cope with.

Toxicological profile and safety evaluation of antifungal azole derivatives.

For the development of new systemically acting, oral antifungal azoles, it is of key importance to compare them with ketoconazole, the first available drug in this therapeutic class. Ketoconazole is a major breakthrough although hepatic side-effects as well as interactions with mammalian steroids might rarely occur during prolonged treatment. The prediction of these side-effects is difficult but the potential to interact with mammalian cytochrome P-450 enzymes is considered to be important. Therefore, for the selection of itraconazole a multidisciplinary approach was applied to study this potential. The present paper deals with the toxicological profile of itraconazole and its safety evaluation. In addition, a further comparison with ketoconazole and also with fluconazole is provided, in so far sufficient information is available. For the liver as a potential target organ, the available data indicate that itraconazole is not a predictable hepatotoxic drug in man. The major endocrine targets for overdosing with antifungal azoles are the adrenal cortex and the gonads. Endocrine studies show that itraconazole is not bearing a potential to interfere with steroid hormones in patients, which is a major improvement when compared to ketoconazole. In rats, elevation of serum cholesterol is observed especially after chronic exposure to itraconazole. This species-specific phenomenon leads at toxic dose levels to secondary events, especially in the long-term toxicity studies. In man, including those with existing hypercholesterolemia, serum cholesterol is not adversely affected by itraconazole. In pregnant rats, ketoconazole was shown to be teratogenic at high, toxic doses. The same observation has been made for itraconazole and this also might be true for fluconazole.(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of the age on 5'-nucleotidase activity associated with the rat liver plasma membrane]. / Influenza dell'età sull'attività della 5'-nucleotidasi associata alla membrana plasmatica da fegato di ratto.

The influence of age on the isothermic and temperature-induced kinetics of the plasma membrane 5'-nucleotidase was studied in rat liver. The apparent Km values increased with age, while the Vmax, the temperature discontinuity and the Ex above and below the max break were unaffected.