Disorders of Sex Development (DSD): Peer Relations and Psychosocial Well-Being

Social and emotional development is shaped by familial and extra-familial experiences especially interactions with peers. Children and adolescents with physical, behavioral or developmental differences, such as youth with disorders of sex development (DSD), may not benefit to the same degree as other children and adolescents from experiences with peers. This paper reviews current thinking about the features and effects of experiences with peers and the potential challenges of peer interactions for children and adolescents with DSD. We review findings from studies of adjustment for individuals with DSD. We finish the paper with a brief outline of a research agenda to promote the understanding of adjustment of individuals with DSD.

Mayer-Rokitansky-Küster-Hauser syndrome: sexuality, psychological effects, and quality of life

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital condition in which a genetic female is born with vaginal agenesis and a rudimentary to absent uterus. This condition affects a woman's ability to menstruate, to engage in penile-vaginal intercourse, and to bear children. Much has been published about how best to create a neovagina in women with MRKH, but little has been written about the psychological impact of MRKH and quality of life outcomes for women with the condition. A review of the extant literature published from 1955 to 2007 supports that (1) surgical or non-surgical creation of a neovagina alone does not ensure a successful psychological outcome, (2) psychological support at critical times can be helpful, and (3) how professionals use language to discuss the condition may positively or negatively influence a female's experience of MRKH. This article discusses the implications that existing knowledge has on future research and on clinical practice. Understanding how women with MRKH cope with and adjust to the condition will help healthcare professionals provide optimal care.

Treatment of non-union of the forearm using distraction-compression osteogenesis

BACKGROUND

The goal of the study is presentation broad abilities like gives Ilizarov method in the treatment of posttraumatic nonunion the of forearm with concomitant shortening and axis deformity, in minimally invasive technique, with contemporary axis correction and lengthening .

MATERIAL AND METHODS

. Authors present 6 patient operated on with the use of Ilizarov method, in years 2001-2005 , suffer from vital nonunion of the forearm - 6 cases radius; 1 case ulna and radius. In all cases with nonunion concomitant shortening of the radius from 2 to 3 cm and valgosity of radius with deformity in sagittal plane in 4 patients (2antecurvation, 2 retrocurvation). All patients had restricted rotation ROM of forearm and restriction of wrist motion . Author's modification of Ilizarov apparatus (with mini-Schanz's half-pins, which permitted rotation of forearm) was used in most of patients. In 3 cases monofocal slow correction with lengthening within nonunion was performed. In 2 cases bifocal, one-step slow correction of deformity and compression within nonunion with lengthening was performed. In 1 remaining case compression of ulna nonunion and compression with deformity correction of radius nonunion were performed. Distraction and correction start in 7 postoperative day in rate from 0,25 to 1 mm/day and correspondingly from1 to 2o/day.

RESULTS

Time of correction and distraction was average 63,3 days (40 - 90 days) . Total time of stabilization was average 25,4 weeks (20 - 35 weeks). Bone union was obtained in all patients. In all cases considerable recovery of limb function was achieved. All patients had superficial pin-tract infection . One patient had staphylococcal pin-tract infection of soft tissues, which retreat after 3-weeks guided antibiotic therapy.

CONCLUSION

The Ilizarov method permit for contemporary axis correction and/or distraction or compression. There is the method of choice in the treatment of nonunion of forearm with concomitant shortening and axis deformity.

Secondary amoebic eye infections in mice due to Acanthamoeba sp

The aim of the present study was to determine the occurrence of eye infections accompanying the infection of the central nervous system and to demonstrate the possible tissue affinity of different strains of amoebae in subsequent infections. The results obtained demonstrate a clear correlation between the occurrence of eye infection and the degree of virulence of the strains. Amoebae isolated from eyeballs and other organs of dead mice did not exhibit any specificity in relation to the organs in subsequent infections. Irrespective of the place of isolation--be it eye or brain--in the subsequent passages, the amoebae were most often found in the brain and lungs, followed only then by the eye of the infected animals.

Extracerebral infections of Acanthamoeba spp. in mice. pathomorphological changes in tissues of infected animals

A variety of Acanthamoeba spp. pathogenic strains were isolated from water pools in the area of Poznań. In many cases amoebae invaded lungs, kidney heart, liver and diaphragm causing significant changes in these Organs. The presence of amoeba outside of CNS was found mainly in the early periods of infection. Amoeba isolated from different organs of dead animals did not exhibit any specificity in relation to the organs in following infections. Infection with both low-and high-virulent strains resulted in pathomorphological changes of similar character. However, changes induced by low-virulent parasites developed later and were less extensive.

Biosynthesis of prostaglandins in pathogenic and nonpathogenic strains of Acanthamoeba spp

The aim of the present study was to examine the biosynthesis of prostaglandins and to investigate factors conditioning their biosynthesis in pathogenic and nonpathogenic strains of Acanthamoeba spp. We established that the activity of the synthase of prostaglandins was almost identical in pathogenic and non-pathogenic strains and that the synthesis of endoperoxide prostaglandins was similar to that of other organisms up to the point at which prostaglandin H2 was produced. The course of biosynthesis in vitro can be activated by various compounds such as glutathione, albumin, and p-chloromercuribenzoic acid (p-CMB), which are either activators or inhibitors of the enzymes. We suggest that the course of biosynthesis of prostaglandins in vivo is most probably activated by tissues or constitutional liquids surrounding the parasites.

The duration of the cyst stage and the viability and virulence of Acanthamoeba isolates

The viability of Acanthamoeba cysts after they have been stored in water at 4 degrees C for a period of 24 years was determined and to estimate their present degree of virulence as compared to its primary values. The viability of 17 amoebae isolates was examined using the eosin exclusion and in vitro excystation on agar plates (NNE). After the period of 24 years, only 3 isolates were found dead. The remaining 14 isolates after inoculation on NNE gave rise to new subcultures, although the percentage of living cysts measured by eosin exclusion was low (0-5%). Separate groups of mice were inoculated intranasally with 10 subcultures characterised by varying primary virulence. It was found that in 8 groups the mice were invaded (at varying degree), and some of them died. Taking into consideration the fact that some of the examined isolates completely lost their virulence only after 8 years of the in vitro cultivation, the obtained results are very intriguing. On the ground of these results one can assume that in the natural environment the period of viability for a cyst may be not shorter than 25 years, and, which is even more essential, they can maintain their invasive properties.

The effect of the passages of Acanthamoeba strains through mice tissues on their virulence and its biochemical markers

The aim of this study was to determine the enzymatic differences in the process of increasing the degree of virulence in attenuated Acanthamoeba strains as well as strains freshly isolated from the natural environment. The data obtained in our studies indicate that by intranasal infection of mice, one can restore virulence in primary virulent strains and make virulent strains that primarily were noninvasive. The levels of peroxidase and proteinase activity measured thoroughly correlated with the increase in the degree of virulence observed during the process of making the amoeba virulent by inoculating them into mice. We observed that in cases in which the activity of peroxidase and proteinase was higher than 0.150 units/mg protein and 8 units/mg protein, respectively, some of the animals infected with the strains showing this activity of peroxidase and proteinase died. In nonvirulent strains as well as in poorly virulent strains, we observed a decidedly lower activity of these enzymes.

[Amebic keratitis-keratitis acanthamoeba]

In seventeen patients who suffered of corneal ulcer, and were negative in bacteriological and mycological examinations, parasitological tests were performed between 1990-1992. Acanthamoeba keratitis was diagnosed in one patient with characteristic corneal changes of right eye following trauma. The patient was not a contact lens wearer. The amoeba found in direct smears of scraping from corneal ulcer and isolated and cloned in in vitro conditions (isolate-clone-No. 2961) belonged to Acanthamoeba polyphaga species. The trophozoites showed a low degree of invasiveness and high virulence when tested in BALB/c mice. The authors discussed the epidemiology of Acanthamoeba keratitis and pointed out to the necessity of accurate laboratory diagnosis and discerning interpretation of the results to prevent an Acanthamoeba-phobia among the potential patients and most of all among the medical staff.

Proteolytic enzymes of pathogenic and non-pathogenic strains of Acanthamoeba spp

The aim of this work was biochemical characterization and classification of proteinases in pathogenic and non-pathogenic strains of Acanthamoeba spp. The authors showed two proteinase (acid 35 kDa and alkaline 65 kDa) which could be separated electrophoretically. Acid proteinase was inhibited by serine proteinase inhibitors such as DIFP. The second enzyme which was active at alkaline pH, was enhanced by EDTA and inhibited by iodoacetate (IAA) and (p-CMB) p-chloromercuribenzoate. These substances are known to inhibit cysteine type proteinases. The alkaline proteinase was more distinctively active in pathogenic strains and belongs to cysteine class (EC 3.4.22), whereas the acid proteinase was similar active in pathogenic and non-pathogenic strains and belong to serine class (EC 3.4.21).

Biochemical markers of pathogenicity and virulence of Acanthamoeba sp. strains

The aim of our study was to demonstrate a possible correlation between some biochemical and biological markers of the degree of virulence of the investigated strains of Acanthamoeba sp. The results obtained demonstrated a significant correlation between the activity of proteases, peroxidases, and superoxide dismutase and the degree of virulence of the strains as previously defined by tests on mice. The results also proved that the strains that killed some of the infected mice were characterized by the highest value recorded for the activity of peroxidase and the lowest value obtained for the activity of superoxide dismutase.

Pubertal disorders. Psychology and clinical management

The behavioral data reviewed herein must be viewed with caution. Although there are reports that adhere to rigorous methodology, these are the exception. Most reports do not adequately describe either the methodology used or their sample. Subjects are often of mixed endocrine diagnoses, and sometimes the results are of both boys and girls. All of these pitfalls make interpretation of results difficult and limiting. With this in mind, the following conclusions are offered. The majority of behavioral data on precocious puberty comes from studies of IPP in girls. Cognitively, IPP has been associated with average to high-average intelligence. Purportedly, the finding of lower visual-spatial skills than verbal skills in early maturing boys and girls has received equivocal support by cognitive studies of IPP individuals. Similarly, clear differences in hemispheric lateralization have not been demonstrated. Aside from increased somatic complaints during the nonmenstrual phases of their menstrual cycle, girls with IPP show a spectrum of behavior adjustments. Major psychopathology is rare. Clearly, their early development makes them look older than their actual age, which probably alters the expectations others have for them. Psychosexually, however, IPP girls develop in concert with their chronologic age and social experience, rather than their early biologic maturation. However, recent reports suggest a modest influence of hormones. In summary, these studies support an interactionist theory of human psychosexual development. Research data on IPP girls suggest that they do not significantly differ from girls who are early maturers but within the normal range. Research on these girls indicates that most negotiate their puberty without severe problems. There has been less research on IPP boys because it occurs so rarely. Most of what is understood about precocious puberty in boys comes from boys with precocious puberty secondary to poorly controlled CAH. Behavioral data on individuals with delayed puberty come almost exclusively from boys. Although CD appears to be the most frequently diagnosed form of delayed puberty and does not reflect a known pathologic process, men with CD as well as those with organic disorders appear to be at risk for psychosocial and psychosexual difficulties. These difficulties are not severe forms of psychopathology. Rather, they probably represent problems negotiating the expected adolescent lessons of psychosocial development with a physique that places them at a disadvantage. They clearly look younger than their actual chronologic age. Cognitively, as with the children with precocious puberty, there is no evidence of intellectual impairment associated with delayed puberty.(ABSTRACT TRUNCATED AT 400 WORDS)

Management of male pseudohermaphroditism: a case report spanning twenty-one years

Management of infants born with ambiguous sex organs requires the close collaboration of a team of professionals: pediatric endocrinologist, pediatric psychologist, gynecologist, and surgeon. The interdisciplinary teamwork of a group of professionals is described in the case of a patient announced at birth as a male but within days reannounced and reared as a female. Over the next 21 years, she became completely aware of her endocrine condition, including its medical classification (male pseudohermaphroditism), her chromosomal (46 XY) and gonadal (testes) status, and her early history of male sex assignment. The clinical management described herein helped this person deal effectively with her condition despite unsuccessful reconstructive vagal surgery. Substantiation of this is provided by the patient's personal comments.