Modelling copper toxicokinetics in the zebra mussel, Dreissena polymorpha, under chronic exposures at various pH and sodium concentrations.

The stenohaline zebra mussel, Dreissena polymorpha, is uniquely sensitive to the ionic composition of its aquatic environment. Waterborne copper (Cu) uptake and accumulation in zebra mussels were examined at various conditions in an environmentally relevant range in freshwater, i.e. Cu exposure levels (nominal concentrations of 25 and 50 µg/L), pH (5.8-8.3), and sodium (Na+) concentrations (up to 4.0 mM). Copper accumulation was simulated by a kinetic model covering two compartments, the gills and the remaining tissues. The Cu uptake rate constant decreased with decreasing pH from 8.3 down to 6.5, indicating interactions between H+ and Cu at uptake sites. The kinetic simulation showed dose-dependent effects of Na+ on Cu uptake. At 25 µg/L Cu, addition of Na+ at 0.5 mM significantly inhibited the Cu uptake rate, while no significant differences were found in the uptake rate upon further addition of Na+ up to a concentration of 4.0 mM. At 50 µg/L Cu, the Cu uptake rate was not influenced by Na+ addition. Calibration results exhibited dose-dependent elimination rates with more profound elimination with increasing exposure levels. With kinetic parameters calibrated at environmentally relevant conditions, in terms of pH and Na+ concentrations, the model performed well in predicting Cu accumulation based on independent data sets. Estimates of the Cu concentration in mussels were within a factor of 2 of the measurements. This demonstrates potential application of kinetic models that are calibrated in environmentally relevant freshwater conditions.

Treatment with levetiracetam in a patient with pervasive developmental disorders, severe intellectual disability, self-injurious behavior, and seizures: a case report.

Pervasive developmental disorder is characterized by various symptoms that often include self-injurious behavior (SIB). Episodes of SIB occur in the context of high emotional arousal, anger, or fear and may be related to epilepsy. We report the case of a 20-year-old man with pervasive developmental disorder presenting with SIB non-responsive to antipsychotic medication. Positron emission tomography showed a right temporoparietal hypometabolic focal lesion suggestive of an epileptic focus. Two weeks after initiation of levetiracetam (Keppra®), SIB disappeared, without recurrence 24 months later. Levetiracetam (Keppra®) may be beneficial for such patients.

Longitudinal analyses of renal lesions due to acute pyelonephritis in children and their impact on renal growth.

PURPOSE: Acute pyelonephritis is a common condition in children, and can lead to renal scarring. The aim of this study was to analyze the progression of renal scarring with time and its impact on renal growth. MATERIALS AND METHODS: A total of 50 children who had renal scarring on dimercapto-succinic acid scan 6 months after acute pyelonephritis underwent a repeat scan 3 years later. Lesion changes were evaluated by 3 blinded observers, and were classified as no change, partial resolution or complete disappearance. Renal size at time of acute pyelonephritis and after 3 years was obtained by ultrasound, and renal growth was assessed comparing z-score for age between the 2 measures. Robust linear regression was used to identify determinants of renal growth. RESULTS: At 6 months after acute pyelonephritis 88 scars were observed in 100 renal units. No change was observed in 27%, partial resolution in 63% and complete disappearance in 9% of lesions. Overall, 72% of lesions improved. Increased number of scars was associated with high grade vesicoureteral reflux (p = 0.02). Multivariate analysis showed that the number of scars was the most important parameter leading to decreased renal growth (CI -1.05 to -0.35, p <0.001), and with 3 or more scars this finding was highly significant on univariate analysis (-1.59, CI -2.10 to -1.09, p <0.0001). CONCLUSIONS: Even 6 months after acute pyelonephritis 72% of dimercapto-succinic acid defects improved, demonstrating that some of the lesions may be not definitive. The number of scars was significantly associated with loss of renal growth at 3 years.

The selective amobarbital test in the anterior choroidal artery: perfusion pattern assessed by intraarterial SPECT and prediction of postoperative verbal memory.

To screen for patients at risk for memory decline after temporal lobe epilepsy (TLE) surgery, selective amobarbital procedures, such as injection into the anterior choroidal artery (ACA-IAT), are sometimes used. We investigated the extent of the territory affected during ACA-IAT and its predictive value with respect to postoperative memory. Seventeen patients with TLE underwent ACA-IAT. In 9 of 17 patients, intraarterial SPECT co-registrated to MRI allowed delineation of amobarbital-perfused structures. Another subgroup of 9 of 17 patients underwent anterior temporal lobectomy. Verbal memory was tested pre- and postoperatively and during ACA-IAT. Major variations in the ACA-IAT perfusion pattern occurred and were not correlated with the verbal memory scores during ACA-IAT. Postoperatively, no patient experienced a severe verbal memory decline, but individual postoperative performance was not correlated with results during ACA-IAT. Our study suggests that ACA-IAT can be used to screen for severe postoperative amnesia in inconclusive cases, but cannot predict individual outcome, even when the perfusion pattern is taken into account.

Sentinel lymph node involvement and a high Breslow index are independent factors of risk for early relapse of melanoma.

AIM: The clinical relevance of sentinel lymph node (SLN) analysis was evaluated prospectively and compared with other known risk factors of relapse in early stage melanoma. METHODS: Surgery was guided by lymphoscintigraphy, blue dye and gamma probe detection. SLN were analysed by haematoxylin eosin (HE) histochemistry and multimarker immunohistochemistry (IHC). Disease free survival (DFS) was evaluated with Kaplan-Meier plots according to different parameters and Cox analyses of variance. RESULTS: From 210 patients a total of 381 SLN were excised. Lymphoscintigraphy identified all excised SLN with only 2 false positive lymphatic lakes. Fifty patients (24%) had tumour positive SLN. With a mean follow-up of 31.3 months, 29 tumour recurrences were observed, 19 (38%) in 50 SLN positive and 10 (6%) in 160 SLN negative patients. Strong predictive factors for early relapse (p < 0.0005) were SLN positivity and a high Breslow index. CONCLUSION: SLN tumour positivity is an independent factor of high risk for early relapse with a higher power of discrimination than the Breslow index.

Multimodality imaging for focus localization in pediatric pharmacoresistant epilepsy.

UNLABELLED: Multiple structural and functional imaging modalities are available to localize the epileptogenic focus. In pre-surgical evaluation of children with pharmacoresistant epilepsy, investigations with the maximum yield should be considered in order to reduce the complexity of the workup. OBJECTIVE: To determine the extent to which PET, ictal/interictal SPECT and its co-registration with the patient's MRI contributes to correct localization of the epileptogenic focus, surgical intervention and to the post surgical outcome in paediatric patients. METHODS: The study population included children and adolescents with pharmacoresistant epilepsy (n = 50) who underwent preoperative evaluation, surgery and had postoperative follow-up for at least 12 months. Outcome was measured by postoperative seizure frequency using Engel's classification. RESULTS: Thirty-nine patients (78%) became completely seizure free after surgical intervention. The likelihood to benefit from surgical treatment was significantly higher if localization with more imaging modalities (MRI, PET, SPECT) were concordant with respect to the resected brain area (p < 0.01). Preoperative PET examination provided better localizing information in patients with extratemporal epilepsy and/or dysplastic lesions, whereas SPECT was found to be superior to PET in patients with temporal lobe epilepsy and/or tumors (p < 0.05). No significant difference was noted in the surgical outcome in younger or older age group, in children with or without special education needs. CONCLUSION: In paediatric epilepsy pre-surgical evaluation, the combined use of multiple functional imaging modalities for a precise localisation of the epileptogenic focus is worthwhile for both extratemporal and temporal lobe epilepsy, also when EEG and MRI alone are non-contributive, given the potential benefit of complete postoperative seizure control.

Bilateral osteonecrosis of the talus and "standing obsession" in a patient with anorexia nervosa.

METHOD: We report a case of a 24-year-old woman with anorexia nervosa (AN), obsessive-compulsive disorder (OCD), and osteoporosis. During 8 years of illness, her body mass index (BMI) fluctuated between 10 and 13,5 kg/m(2). She developed hyperactivity and the habit to stand for all daily activities. She did not allow herself to sit at any time, she had "standing obsession." A few weeks after her admission to an inpatient unit for eating disorders, she reported pain in both ankles. Results and Discussion The rheumatological diagnosis was bilateral osteonecrosis of the talus and generalized osteoporosis. The latter and excessive biomechanical stress could be interpreted as the cause for this serious and irreversible bone destruction. The following case shows how the psychiatric comorbidity of a patient suffering from an eating disorder with a chronic course can lead to severe somatic complications.

Potassium ion release from a glass ionomer cement matrix.

Glass ionomer was mixed with water alone and with water containing two levels of potassium ion, added as potassium chloride. The dimensions of the specimens varied; discs, cylinders and a rectangular bar were used. Release of potassium was measured until it ceased. A little potassium was released from cement mixed with water but could be accounted for by traces present in the glass. Release took 2 months for the lower level and 1.5 years for the higher level of addition. For some specimen groups not all the potassium added was subsequently released. Potassium release tended towards the pattern found for fluoride release naturally occurring from glass ionomer cements in being proportional to t 1/2 but was less certain at the lower addition. Release was not related to the dimensions of the sample as has been shown for release of intrinsic fluoride.

[Catamnestic study of ecological brief therapy]. / Katamnestische Untersuchung der Okologischen Kurztherapie.

Ecological brief psychotherapy has been practised at the Psychiatric Outpatient Clinic at the University Hospital Zurich since 1990. The aim is to use the development-oriented challenges posed by important others in the therapeutic process. The effectiveness of this form of therapy is investigated by reviewing the outcome of 28 completed treatment cases. While results at completion of therapy come up to the expectations, the long-term results were surprisingly positive. 96.4% of those surveyed reported they felt considerably better at final assessment 1 to 6 years after the therapy than they did at the beginning. Positive changes continued after the completion of therapy. We presume that our coevolutive focus brought resolution of blocked developmental steps in relationships that further stimulated changes that continued after the conclusion of therapy, even without further therapeutic support. Furthermore, the treatment effects provided by ecological brief psychotherapy apply to personality disorders as well.

Psychotherapy of panic syndrome: focusing on ecological aspects of relationships.

Cognitive Behavioral Therapy (CBT) has been shown to be an effective symptomatic treatment for panic attacks; however, this paper recommends complementing it with an approach based on an interactive ecological model. The approach is based on the thesis that a panic syndrome can occur if patients block an impending and/or already initiated development of their relationships, especially involving partners or work. The case may be that, over a period of years, phobic attitudes and behavior described further in the text have enabled patients to maintain a socially positive shaping of their personal niches. Later, phobic avoidance behavior is no longer adequate due to the requirements of the new stage of life. Unconsciously, patients configure an outer relationship situation that demands of them the realization of the impending step in development. Therapy should utilize this relationship configuration.

[Investigation of personal niche as basis of supportive psychotherapy]. / Die Erfassung der persönlichen Nische als Grundlage der supportiven Psychotherapie.

According to the ecological theory of Willi 1996, people create and maintain their psychic wellbeing through constant shaping of their environment, i.e. setting up a personal niche. The personal niche in turn responds to, guides and challenges further personal development. This study explores what kind of solutions single patients with psychiatric invalidity can find in order to form their environment as a niche in which they may develop effectiveness and use it for their psychic regulation. 30 people were questioned with a semi-structured interview: they were patients of a psychiatric out-patient's clinic, living alone and psychiatrically invalidated (2/3 with schizophrenia of the residual type). The results were ranked after their increasing demands in a relational and in an activity inventory. The more relationship is based on mutuality expectations of others, personal disclosure and binding the more the subjects feel overstrained. The investigation of these inventories serve as a technical aid in supportive psychotherapy.

[In the grey area body body, psyche and social difficulties. I: New developments in diagnosis and therapy of somatoform disorders (exemplified by chronic pain patients)]. / Im Graubereich zwischen Körper, Psyche und sozialen Schwierigkeiten. Teil I: Neue Entwicklungen in der Diagnose und Therapie von somatoformen Störungen (am Beispiel von chronischen Schmerzpatienten).

The so-called psychosomatic or functional conditions (notably somatoform pain disorders) often cause difficulties in diagnostic classification, clinical management and assessment of disability. Recent trends in diagnosis are reviewed. We describe our first clinical experience of interdisciplinary evaluation of pain patients by functional capacity evaluation and an ergonomically oriented rehabilitation program. This interdisciplinary approach could constitute a new field of close collaboration between physiatry/physical medicine, physiotherapy and psychiatry.

[In the gray area between body, psyche and social difficulties. II: Psychiatric assessment of somatoform disorders (exemplified by chronic pain patients]. / Im Graubereich zwischen Körper, Psyche und sozialen Schwierigkeiten. Teil II: Die psychiatrische Begutachtung von somatoformen Störungen (am Beispiel von chronischen Schmerzpatienten).

Medico-legal assessment for long-term disability benefits in patients with mainly somatoform pain disorders is in increasing demand. Since impairment does not explain the loss of function in somatoform disorders, the expert must determine to what extent the patient is able to cope more actively with pain in order to attain a higher level of functioning. Consistency of behavioral signs, flexibility and initiative in the way of coping are helpful criteria in this respect. Special attention is given to problems in the assessment of migrants with these disorders. We strongly support the concept of an interdisciplinary approach in medico-legal assessment. Postgraduate medical training in this field should receive greater attention accordingly.

The significance of romantic love for marriage.

In this study, 605 subjects were asked about romantic love and marriage. Married people differentiated themselves from single people with stable partners and divorced people with new partners by more frequently living together with their great love, more reciprocity in that love, and less disappointments in love relationships prior to the current relationship; but they also described themselves as less happy and satisfied than the single and divorced respondents, particularly with regard to tenderness, sex, and conversation with their partners. Independent of marital status, those who were greatly in love with their partners describe themselves as happier. Love at first sight, relative to a gradually developing love, nevertheless, did not have a worse prognosis for happiness in marriage. Being in love seems to be of greater importance for the prognosis of the marriage than marital happiness and satisfaction.

[The co-evolutional focus in individual, couple and family therapy]. / Der koevolutive Fokus in der Einzel-, Paar- und Familientherapie.

A concrete formulation of focus is proposed that in structure and use is suitable for individual as well as couples and family therapy. The concept of coevolution (Willi 1985, 1991) forms a basis for the supposition that important personal developments are realised in human relationships. The development of one person is challenged, taxed, or hindered by the development of other persons. The formulation of a coevolutional focus consists of four steps: 1) The context of the relationship in which the current conflict emerges; 2) The identification of delayed stages of development; 3) The personal and interactional conditions which block this development; 4) Concrete changes which make the progress in the intended development recognizable. The focus in couples and family therapy integrates the impending development of the participants in their collusive interactions.

[People in divorce and their ambivalence: initial use of a newly developed couples inventory]. / Menschen in Trennung und ihre Ambivalenz: Erste Anwendung eines neu entwickelten Paarinventars.

It has been reported that intact internal, external and social accommodation is related to a stable partnership between men and women. Every partnership, however, is also characterized by a certain potential towards separation that may develop despite of the named stabilizing factors. This led to the question of how the accommodation is constituted in men and women during separation. A written questionnaire was, therefore, sent to a total of 35 men and women in separation. The Bradburn inventory was used to define the well-being of the volunteers in relation to a representative sample. Using a newly developed inventory, a number of items had to be rated twice: once to reflect the condition at the beginning of the partnership and once to reflect the situation during the last year. In addition, the relative contribution of a particular item in favor or against separation was asked. The Bradburn inventory shows that the general well-being of the test sample is more impaired than that of the representative sample. The evaluation of the 80% returned questionnaires revealed worsening of all items. Most important reasons to finish the partnership were i) the lack of verbal communication, ii) extramarital affairs, and iii) the impression that the partnership limits the personal development. Reasons to continue the partnership were different between those who initiated the separation and those who were left: The initiators predominantly mentioned structural factors such as financial situation, living conditions and care for children, whereas the non-initiators predominantly mentioned internal qualities of the partnership.(ABSTRACT TRUNCATED AT 250 WORDS)

Couples therapy using the technique of construct differentiation.

A central problem in couples therapy is the clients' tendency to persist in endless and fruitless alternation between attacking the partner and justifying themselves. The technique of construct differentiation described in this article has proved helpful in coping with this situation. In three clearly structured steps, the therapist explores the personal constructs of each partner in the presence of the other. Instead of concentrating in the usual way on circularity of thoughts, feelings, and behavior, the partners are hindered from interacting and are confronted by the therapist's questions concerning their own inner process, independently of that of the partner. By becoming aware of their own ambivalent constructs and those of the partner, the eagerness to convert the partner to their own point of view can be reduced, and the construct system of each partner can be enriched by the other's constructs. Construct differentiation proves especially useful in the treatment of power struggles and narcissistic collusions.

[Psycho-ecologic aspects of defense mechanisms]. / Psychoökologische Aspekte der Abwehr.

Classical defense mechanisms are used not only intraindividually to strengthen a threatened ego-Organization, but also between individuals to stabilise endangered social relationships. According to a psychoecological way of thinking, any person has an existential need of productive, ongoing, mutual exchange in his or her social niches, in particular in those situations in which the inner equilibrium is threatened. Social relationships are used to support the threatened person in the use of classical defense mechanisms. People close to the individual have an important influence on reinforcing or weakening of the intrapersonal defenses, and therapists have to learn to take this into account.

Exploring the doctor-patient relationship reduces staff stress and enhances empathy when caring for AIDS patients.

At our AIDS outpatient clinic we presently care for more than 1,200 HIV-infected patients. All physicians in this unit have participated for 1 year in a case work group supervised by a liaison psychiatrist. The doctor-patient relationship, the assessment in the case work group and the ensuing influence on perception and behavior are demonstrated by 3 cases. Different issues challenge the doctor-patient relationship: the serious prognosis of predominantly young AIDS patients; isolation and stigmatization of patients; fear of contagion, and questions of confidentiality regarding contact tracing. Reflection upon the doctor-patient relationship improves communication skills and increases empathy towards AIDS patients.