Practical guidelines for the assessment and treatment of selective mutism.

OBJECTIVE: To provide practical guidelines for the assessment and treatment of children with selective mutism, in light of the recent hypothesis that selective mutism might be best conceptualized as a childhood anxiety disorder. METHOD: An extensive literature review was completed on the phenomenology, evaluation, and treatment of children with selective mutism. Additional recommendations were based on clinical experience from the authors' selective mutism clinic. RESULTS: No systematic studies of the phenomenology of children with selective mutism were found. Reports described diverse and primarily noncontrolled treatment approaches with minimal follow-up information. Assessment and treatment options for selective mutism are presented, based on new hypotheses that focus on the anxiety component of this disorder. Ongoing research suggests a role for behavior modification and pharmacotherapy similar to the approaches used for adults with social phobia. CONCLUSION: Selectively mute children deserve a comprehensive evaluation to identify primary and comorbid problems that might require treatment. A school-based multidisciplinary individualized treatment plan is recommended, involving the combined effort of teachers, clinicians, and parents with home- and clinic-based interventions (individual and family psychotherapy, pharmacotherapy) as required.

Early sex differences in hormonal potentialities of gonads from quail embryos with a sex-linked pigmentation marker: an in vitro radioimmunoassay study.

Quail embryos with a sex-linked eye pigmentation marker allowing sex identification at autopsy provided a biological model for radioimmunoassay of sex steroids in embryonic quail gonads at a very early stage (51/2 and 61/2 days). The purpose was to demonstrate a sex difference in hormonal potentialities of the gonads before any morphological indication of sexual differentiation. Evidence of early steroidogenesis by undifferentiated gonads could be obtained: estrogen synthesis characterized female gonads, while testosterone was produced by the gonads of both sexes. The sex hormonal production was concomitant with, or even preceded, the apparent beginning of sex differentiation of gonads.

Effects of early tamoxifen treatment on hormonal content of 15-day quail embryo gonads.

An early treatment of quail eggs with an antiestrogen (Tamoxifen = TAM) modifies the female gonads morphologically. In the left ovary, the proliferation of the germinal epithelium and formation of a cortex is markedly inhibited, while the medulla on both sides becomes more developed and keeps a cordal organization. The effects of TAM on the hormonal potentialities of 15-day embryo gonads have been investigated by radioimmunoassay. The data have been compared with those of normal gonads. The results indicate that the TAM treatment does not mainly modify the hormonal levels and patterns in the gonads of both sexes and does not inhibit the function of the hypothalamo-hypophyseal-gonadal axis. The reduced cortical development is thus not linked to an estrogen decrease but to competitive effects on receptors at the level of this tissue.

Control of the hormonal secretions of quail embryo gonads (normal and DES-treated): in vitro effects of testosterone and of hCG.

In vitro effects of factors such as testosterone or hCG on steroidogenesis by 12-day quail embryo gonads have been investigated by radioimmunoassays. The purpose was to compare the hormonal potentialities (estradiol, estrone, and dihydrotestosterone; E1, E2, DHT) of normal and diethylstilbestrol-treated gonads. The results demonstrate that the reduced steroid production by the treated ovaries does not result from their inability to respond to both factors, but reflects their weakened stimulation in vivo at the time of explantation. On the other hand, the secreting abilities of the DES-treated male gonads do not greatly differ from those of normal testes; even in the presence of favorable factors, and despite their feminization, the ovotestes are effectively unable to produce significative amounts of estradiol. These results are compared with others obtained elsewhere in quail and in chick embryos.

Effects of early hypophysectomy in the aging rat ovary. Ultrastructural study on regression and on delayed epithelial proliferation in the interstitial tissue.

This report describes the fine structure of the "wheel" cells and of epithelial structures which both characterize the interstitial tissue of hypophysectomized and intact senescent rats. The regressive changes induced in normal ovarian interstitial cells of 25-26 day-old hypophysectomized rats were studied from 7 days to 15 months after the operation. They mainly consist in a rapid cytoplasmic dedifferentiation of these steroidogenic cells which, by one month after hypophysectomy, could be only identified by their specific nuclear pattern ("wheel" cells). Further changes of their organelles are only quantitative. These interstitial cells become perennial cells with no ultrastructural signs of senescence. In one year-old animals, the presence of both epithelial testis-like tubes and epithelial cellular cords provides evidence that these structures represent two different morphological arrangements for a similar cellular aspect. Unlike established "wheel" cells, these epithelial structures are evolutive and the thickening of their basement membrane can be considered as an age criterion. The follicular origin of the testis-like tubes and the complex formation of the cords are discussed in the light of our previous photonic study and compared with similar structures occurring in the senile rat ovary and in other situations.

[Inhibitory effects of tamoxifen on the normal differentiation of the female gonads of the quail embryo]. / Action antagoniste du tamoxifene sur la differenciation normale des gonades femelles de l'embryon de Caille.

Early treatment of Quail eggs by tamoxifen produces a striking inhibition on normal differentiation of the female gonads. This anti-estrogen restricts cortical proliferation in the ovary while it favours the development of the medulla of both gonads. As a result their morphology and organization diverge toward a more neutral or even testicular pattern. Since tamoxifen is able to compete with the endogenous estrogens, these results underline their role in female differentiation of the Quail gonads.

[Chick embryo ovarian differentiation after experimental mesonephros agenesis (author's transl)]. / Différenciation ovarienne chez l'embryon de poulet après agénésie expérimentale du mésonéphros.

Agenesis of the mesonephros was obtained by preventing its early induction by the Wolffian duct. In the older embryos (14 to 19 days) studied, the ovaries differentiated in the absence of the underlying mesonephros, but were reduced in size. Their different cell populations (somatic and germinal) were however present and showed typical cytological features. Nevertheless, both components of the ovary, the medulla and the cortex, demonstrated lack of harmonious development. The medulla contained much larger lacunae; the cortex was shrunken with less secondary cords. At these stages, the gonocytes are not yet in premeiosis. These results are discussed in relation to the role of the mesonephros in gonadogenesis and in initiation of meiosis.

Induction of H-Y antigen in the gonads of male quail embryos by diethylstilbestrol.

In quails, H-Y antigen is induced by oestrogens in the gonads of the originally H-Y negative homogametic sex but not in non-gonadal tissues. This is consistent with the view that oestrogens act via H-Y antigen in the organization of the avian gonad.

Feminization of the quail by early diethylstilbestrol treatment: histoenzymological investigations on steroid dehydrogenases in the gonads.

Early treatment of Quail eggs by DES promotes a transient feminization of the gonads in genetic males and a strong stimulation of the Müllerian ducts. The left ovotestis results from the juxtaposition of a testicular medulla and an induced female-type cortex, which develops follicles and a characteristic 17 beta-HSD activity. The right testis is reduced but keeps a consistent structure. The medulla of the treated gonads shows, in both sexes, an inhibition of delta 5-3 beta HSD activity during embryonic development. After hatching, this specific enzyme then develops in the steroidogenic cells. These results are compared with others obtained with estradiol and also in chick. The discussion deals also with the effects of these estrogens on the endogenous abilities and specific responses of the gonads in relation to sex differentiation factors.

[Retroperitoneal injuries: fractures of the spine and pelvis (author's transl)]. / Retroperitonealverletzungen: Wirbelsäulen- und Beckenfraktur.

Within the area of retroperitoneal injuries, bone injuries of the spine and pelvis are discussed in terms of immediate diagnosis and early treatment. Particular attention should be given to the required operative position and to the intensive postoperative care in terms of the stability or instability of spinal injuries. In view of the total injury, pelvic fractures are often underrated. Extreme blood loss is to be expected in dorsal and ventral vertical fractures and luxations. Irreductible dorsal luxations should be surgically set and stabilized.

Light and electron microscopy of the ovarian interstitial tissue in the senile rat: normal aspect and response to HCG of "deficiency cells' and 'epithelial cords'.

The two components of the interstitial tissue in the senile rat's ovary--deficiency cells and epithelial cellular cords--both contain steroidogenic organelles at a very low level of activity, which can be notably raised by HCG. Deficiency cells and epithelial cords are not the expression of primary ovarian aging, but the consequence of senile gonadotropic hypofunctioning. For that same reason, these ovarian structures become permanent and their possible cellular aging can thus be studied. No ultrastructural signs of senescence have as yet been observed.