The effects of psychotherapies: a study on patients' perception of results in an Italian public setting.

Enquiries centred on the perspective of users of psychiatric treatments and their families, has become an increasingly widespread method to improve the quality of treatments administered by health services. In this study, in particular, we examine the users' perception of the quality and variability of the effects of psychotherapies, the difficulties met, and the perceived help factors. The sample consists of 216 users of psychotherapy and 223 patients in psychiatric treatment with psychological support. They are outpatients, managed by the public health service. The questionnaires included closed ended, open-ended questions and scales that were previously tested on a sample of patients. The questionnaire for patients was anonymous and administered by researchers external to the medical staff. Irrespective of the diagnosis or of a concurrent pharmacological therapy, a high percentage of patients (75%), in both groups, feel improved. Improvement consist of the decrease of symptoms, a sense of feeling better, but also feeling grown up, more mature, having higher self-esteem and feeling more adequate in interpersonal relationships. This last type of result is significantly more frequent in the group of patients in psychotherapy. Besides these patients are faced with more difficulties and play more active a role while they are in treatment. The main difference between patients in psychotherapy and those in psychiatric management with psychological support is not indeed the identification of different perceived therapeutic factors, but rather the different evaluation of their relative importance. On the whole, the study seems to show that the effects of real psychotherapies include, beside an improvement of symptoms, the achievement of goals of personal growth and maturity, self-satisfaction and an increase in self-esteem, all in accordance with a conception of health as well-being and self-satisfaction rather than as absence of illness.

IgG2 deficiency in children with febrile convulsions: a familial study.

The IgG subclasses were investigated in children with febrile convulsions (FC) and in their first degree relatives in the search for a selective immunological deficiency associated with FC and its occurrence in the relatives of affected subjects. The results of the study show lower IgG2 concentrations in FC patients than in controls. But it was not possible to demonstrate familial transmission of the IgG2 subclass deficiency, since it was present only in children with FC and tended to normalize in adulthood. The immunoglobulin subclass deficiency might be responsible for the recurrent infections connected with FC.

Effects of carbamazepine and valproate on immunological assessment in young epileptic patients.

Serum immunoglobulin levels and peripheral blood lymphocyte subsets were determined in 25 epileptic children treated with anticonvulsant drugs [carbamazepine (CBZ) or sodium valproate (VPA)], 17 untreated patients and 18 healthy subjects. The treated and untreated patients did not differ significantly from the controls with respect to the mean IgA, IgG, IgM values or lymphocyte subsets. The patients on carbamazepine had lower serum concentrations of IgG (though not significantly lower) than the untreated patients and children on valproate. OKT8 subset, in absolute terms and as a percentage of total lymphocytes, was significantly higher in generalized than in partial epilepsy, but this was probably due to the antiepileptic treatment. We found a sex difference in serum immunoglobulins (Ig M, IgG) in the epileptic group. Our data do not seem to argue for major changes in immune status related to clinical type of epilepsy or to VPA or CBZ treatment.

Lymphocyte subsets in schizophrenic disorders. Relationship with clinical, neuromorphological and treatment variables.

Peripheral blood lymphocyte subsets and serum immunoglobulin levels were assessed in 42 patients and 37 healthy controls. 24 patients were free from neuroleptic medication and 15 had never been treated with neuroleptics. 31 patients had a diagnosis of schizophrenia (DSM-III criteria) and 11 a diagnosis of a disorder of the schizophrenic spectrum. As compared to healthy subjects, the drug naive schizophrenic patient group showed an increase of T suppressor lymphocytes, while the drug-treated schizophrenic group showed an increase of T helper lymphocytes. The drug-treated schizophrenic group differed from the drug naive one relative to a decrease of T suppressor lymphocytes. As compared to healthy subjects, the drug naive spectrum disorder patients showed an increase of absolute number of lymphocytes, while the drug treated spectrum group showed an increase of B lymphocytes. These findings did not correlate with any clinical or neuromorphological variables taken into account.

Hyperbaric oxygen induced experimental epilepsy: the age factor.

Two methods of inducing convulsions were used in male Swiss albino mice of different ages: exposure to hyperbaric oxygen and pentylenetetrazole treatment. Hyperbaric oxygen proved to be a valid model of experimental epilepsy with an age-dependent trend. The youngest mice presented a much longer convulsion latency time than the adult mice but the curve of distribution of latency time versus age showed progressively increasing sensitivity. Pentylenetetrazole induced convulsions, apart from the youngest subgroup, without variations by age. Hyperbaric oxygen convulsions provide an interesting model for the study not only of the neurochemistry of convulsions but also of the membrane changes that occur in the course of cerebral maturation and aging.

[Intra-arterial digital angiography of the liver and portal system]. / L'angiografia digitale intra-arteriosa del fegato e del sistema portale.

Twenty-seven patients were evaluated by intra-arterial digital subtraction angiography: 20 for portal hypertension--6 also after a porto-systemic shunt--, 4 for evaluation of a hepatic mass and 3 for pancreatic or biliary tumours. Intra-arterial DSA has always shown vascular abnormalities. The advantage of intra-arterial DSA are reduction of the required amount of contrast medium and, consequent, reduction of the frequency of contrast medium reactions. Its disadvantages are limited field size of image intensifier and reduced spatial resolution as compared with conventional angiography. However diagnosis had never been affected by this limitation.

Impact of cancer, type, site, stage and treatment on the nutritional status of patients.

This study analyzed the nutritional status of cancer patients in relation to type and site of origin of the tumor, stage of disease, and previous chemical or radiation therapy. The analysis was performed on 321 patients (280 with cancer and 41 controls). The nutritional parameters included per cent of weight loss, anthropometric indices (arm circumference, triceps skinfold, arm muscle circumference), creatinine-height index, serum protein, albumin, total iron binding capacity and cholinesterase, C3 and C4 components of complement, total peripheral lymphocytes, and skin tests. The statistical comparison between patients with different tumors and controls, between patients with different stages of the same tumor, and between patients treated with or without previous chemical or radiation therapy led to the following conclusions: 1) malnutrition is mainly related to the type and site of origin of the tumor and, in the early stages of disease, is more pronounced in patients with cancer of the esophagus and stomach; 2) except in patients with breast and cervix cancer, malnutrition gets more severe as the disease becomes advanced; 3) chemical or radiation therapy has a variable impact on the nutritional status, but in selected patients it causes a drop in body weight, arm circumference, arm muscle circumference, and peripheral lymphocytes; 4) body weight, cutaneous delayed hypersensitivity and serum albumin are the most commonly altered parameters.

[Natural killer activity in patients with malignant melanoma]. / Attivita' NK (natural killer) in pazienti con melanoma maligno.

Thirty-three malignant melanoma patients were tested for NK cytotoxicity of peripheral blood lymphocytes in a Cr-release assay. NK activity was significantly lower in patients as compared with controls. In eight patients no cytotoxicity whatsoever could be detected. We tried to understand this NK impairment by using further assays such as the removal of plastic adherent cells or of carbonyl-iron phagocytizing cells and by mixing experiments. Only three patients showed the presence of NK activity suppressing cells and one patient had suppressive factors in his serum. No correlation was seen between NK activity values and clinical-biological parameters such as thickness of tumor, stage of disease, rate of recurrences or hystological findings.

HLA antigens in malignant melanoma patients.

One hundred and forty melanoma patients, divided in 2 groups, i.e., patients with clinical evidence of melanoma and patients with no clinical evidence of melanoma, were typed for HLA-A, -B and -C antigens and compared with 340 to 905 (according to each HLA antigen examined) healthy adult blood donors. Overall, a highly significant increase in HLA-B40 antigen (p = 5.6 x 10(-7)) and a decrease in HLA-BW35 (p = 1.6 x 10(-4)) was observed. No relevant difference was found between the 2 groups. Moreover, an unexpected excess of HLA blanks was observed at both A and B loci in the first group (p = 1.3 x 10(-2) and p = 3.3 x 10(-6), respectively) and only at the B locus in the second (p = 1.2 x 10(-2)), when the patients were compared to 288 healthy individuals HLA typed at the same time and with the same HLA antisera as the patients. The increase in HLA blanks in melanoma patients deserves further investigation to ascertain whether it may be due to the tumor not yet surgically removed or may be referred to technical pitfalls.