Socioeconomic status and the Rorschach

People from lower socioeconomic status are making increasing use of mental health facilities. Surveys have indicated that the Rorschach is still one of the more frequently used instruments by psychologists in such facilities, but research has also shown that clinicians tend to misinterpret Rorschachs of people from the lower socioeconomic group as reflecting greater psychopathology than the same Rorschachs identified as being given by people from the middle class. Research has also shown that growing up in conditions of poverty significantly affects how people perform on tests of abstract thinking, tests of intelligence, and tests of academic achievement; the question was raised as to whether this extends to the Rorschach. The lack of sufficient research on the effect of socioeconomic status on responsiveness to the Rorschach precluded that question being answered. The kind of research still needed was discussed.

Influence of salmeterol, a long-acting beta 2-adrenoceptor agonist, on IgE-mediated histamine release from human basophils

Salmeterol, a long-acting beta 2-adrenoceptor agonist, prevents early and late asthmatic responses in atopic asthmatics and inhibits the release of inflammatory mediators from various cells and tissues. We investigated the effect of salmeterol on in vitro basophil histamine release (BHR). Washed basophil leukocytes from allergic (n = 6) and nonallergic subjects (n = 18) were preincubated for 10 min with different concentrations of salmeterol prior to stimulation with antigens (Ag) and anti-IgE for 45 min. BHR was detected by an automated fluorometric assay. If control BHR (without inhibition) reached > or = 30% of the total histamine content, maximal % inhibition (Imax, mean +/- SEM) and the concentration of salmeterol causing 30% inhibition (IC30, geometric mean) were calculated. At concentrations of between 1 and 100 microM salmeterol, concentration-dependent inhibition of release was found for Ag- and anti-IgE-mediated BHR. The Imax of anti-IgE-mediated BHR reached 46 +/- 16% at 30 microM salmeterol. IC30 values were 12 microM for Ag- and 8 microM for anti-IgE-induced BHR. Higher concentrations of salmeterol induced BHR in all subjects (n = 24, 100 microM: 28 +/- 5% BHR), overlapping the inhibitory effect on BHR. Kinetic studies using 30 microM salmeterol (n = 10) showed > 30% inhibition with short preincubation periods (< 10 s). Salbutamol, an older, widely used beta 2-adrenoceptor agonist, had no effect on IgE-mediated BHR (n = 8). We conclude that salmeterol significantly inhibits IgE-mediated histamine release from human leukocytes in the micromolar range.

Surgical interventions in ischemic ventricular tachyarrhythmias--endocardial resection or implanted cardioverter/defibrillator

The surgical therapy of ventricular tachyarrhythmias (VTA) in ischemic heart disease is attracting attention, since current medical therapies are showing limited long-term efficacy. The curative concept of electrophysiologically guided endocardial resection (ER) and palliation with the implantable cardioverter/defibrillator (ICD) are compared retrospectively. From 1980-1992, 121 patients (55 +/- 9 years, 108 males, 13 females) underwent ER and 203 patients (59 +/- 9 years, 195 males, 8 females) received an ICD for ischemic VTA. Concomitant coronary revascularization was performed in 38/121 patients with ER (31%) and in 62/203 patients (31%) with ICD. Perioperative mortality was 8% (10/121 patients) for ER and 5% (10/203 patients) for ICD (P = n.s.). Hundred eleven patients with ER (mean follow-up 41 +/- 37 months) and 193 with ICD (mean follow-up 22 +/- 20 months) were available for survival analysis: freedom from sudden death was comparable for the two groups at 1 year (99% for ICD, and 94% for ER) and at 5 years (90% for ICD and 90% for ER) (P = n.s.). Freedom from cardiac death also showed no differences between the groups at 1 year (94% for ICD, and 84% for ER) and at 5 years (74% for ICD and 74% for ER) (P = n.s.). Left ventricular function, indicated by left ventricular ejection fraction, was comparable (34 +/- 9% in ER, 30 +/- 11% with ICD) (P = n.s.) in the two groups. The linearized incidence of DC-shocks was 10.3/year in ICD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Future time perspective and daily occupations of persons with chronic schizophrenia in a board and care home

OBJECTIVES

An ethnographic approach was used to study the relationship between temporal perspective in persons with chronic schizophrenia and their ability to function in chosen occupations and participate in the routines of a board and care home. Components of future time perspective (extension, coherence, and density) are associated with the ability to organize and implement goal-directed activities. The study focused on how future time perspective occurs in a board and care home, with particular emphasis on how the institution influences temporality.

METHODS

Participant observation and interviewing were used to gather data on 10 subjects.

RESULTS

The pervasive influence of the facility's institutional rules and expectations is revealed in the findings of subjects' present time orientation and limited future time perspective.

CONCLUSIONS

An examination of the fit between the demands of available roles within one's environment and occupations is proposed.

Use of the Rorschach to predict whether a person would benefit from psychotherapy

Research on the use of the Rorschach in predicting response to psychotherapy was reviewed. The research indicates that form level turns out to be the variable which was related to response to treatment, psychiatric as well as psychological, and provided as much information regarding prognosis as could be derived from either the Beck or Klopfer Prognostic Indices. The kind of research now needed in this area of study was discussed.

On the meaning of movement responses on the Rorschach

Research assessing the presumed meanings of M, FM, or m was examined. Since the research did not support the presumed meanings of M, FM, or m, it could be concluded that any interpretation of the psychological meaning of these movement responses is being done on the basis of unsubstantiated belief. Strategies of research to explore the meaning(s) of the various movement responses were discussed.

Surgical treatment of the Wolff-Parkinson-White syndrome--experiences in 120 patients

Since January 1984, 120 patients (78 male, 42 female; aged 3 to 66 years) with the Wolff-Parkinson-White (WPW) syndrome have been operated upon. The indication for surgery was documented recurrent, paroxysmal tachycardia refractory to medical treatment in 118 cases. Twenty-two patients (18%) had additional heart disease. One hundred and twenty patients had a total of 140 accessory pathways (AP). AP were localized at the left free wall in 63% (87 AP), at the right free wall in 24% (35 AP), and septally in 13% (18 AP). Sixteen patients (13%) had multiple AP (12 patients had two and four patients had three AP), 124 AP were known pre-operatively (88%), 133 were localized intra-operatively (94%) and seven were diagnosed during re-operation (6%). Surgery in 28 patients with left lateral AP was via the epicardial approach and the endocardial approach in 59. Of 15 patients with right lateral AP, the surgical approach was epicardial in two and transmural in 13. A cryosurgery was also used in 117 patients. Fifteen patients suffered recurrences, in 12 of whom repeat surgery was required. One hundred and thirty-six AP (97%) were dissected successfully, of which 14 (10%) were ablated during re-operation. All patients survived the initial operation, but two patients died after re-operation. One patient is pacer-dependent due to persisting postoperative atrioventricular (AV) block. We conclude that surgical dissection of accessory pathways can be offered as an alternative to non-surgical treatment modes, at a low risk and with a high success rate.

[Exacerbation of autoimmune hypothyroidism after hemi-hypophysectomy in a patient with Cushing's disease]

A 41 year old woman affected by Cushing's disease underwent hemi-hypophysectomy with removal of an ACTH secreting microadenoma. Forty days later, when normal ACTH, cortisol plasma levels and urinary cortisol levels were restored, features of primary autoimmune hypothyroidism developed. While cortisol levels were elevated serum thyroid hormone levels were normal, serum hormone TSH was at the upper limit of the normal range and serum antimicrosomal antibodies were slightly elevated. It is likely that hypothyroidism already present before surgery was not clinically evident due to the immunosuppressive effect of high cortisol levels. The need to assess thyroid function in patient with hypercortisolism is emphasized with the aim to identify the possible onset of autoimmune thyroid disease when cortisol levels are normalized.

On the validity of hypotheses derived from the Rorschach: the relationship between color and affect, update 1992

A review of research since the last review in 1976 reconfirms the conclusion that how persons will express their emotions does not necessarily bear any relationship to the nature of their responses to color on the Rorschach. It is not only time for clinicians to give up this color-affect hypothesis with regard to Rorschach data but to conduct some basic, exploratory research to examine, empirically, whether a relationship does exist between persons' characteristic modes of expressing their emotions and their characteristic styles of responding to the Rorschach.

Adeno-pituitary hormones in human hypothalamic hypophysial blood

An in vivo technique for collecting blood from the pituitary stalk using transphenoidal microsurgery has recently been developed in men with nonfunctioning pituitary disease. To determine the origin of this blood and the direction of the stream, we measured contemporaneously the levels of LH, FSH, PRL, GH, TSH, and ACTH in hypothalamic-hypophysial blood (HHB) and peripheral blood (PB). Eleven patients with nonfunctioning pituitary adenomas entered the study. The surgical procedure used for collecting HHB consisted of periodically aspirating small amounts of blood using a microsuction apparatus, just after tumor removal, kept in the postero-superior corner of the sella turcica at the junction of the diaphragm with the dursum sellae. The data show clearly the existence of a dramatic concentration gap in HHB vs. PB in all adeno-pituitary hormones (P = 0.003). The HHB/PB ratio varied from 50-600 in the different hormones. The secretion of adeno-pituitary hormones in blood drawn at the pituitary stalk level in man was reported for the first time. The dramatic HHB/PB ratio of the hormone levels has been emphasized. The most likely explanation for the markedly elevated hormone concentration gradient between central and peripheral blood was sampling of peri- and/or suprapituitary blood. To consider the origin and direction of the HHB stream, two hypotheses have been further advanced: 1) a retrograde bloodflow from the pituitary, and 2) a central-hypothalamic secretion.

Use of the hydrogen clearance technique for measurements of pancreatic blood flow

The hydrogen clearance technique (HCT) was employed for measurements of local pancreatic blood flow (PBF) in dogs, opossums, and rats under normal conditions and in opossums during biliary pancreatitis. Local PBF (ml/min/100 g) in dogs was 57.6 +/- 10.4, in opossums 60.6 +/- 9.5, and in rats 144.7 +/- 23.4, under resting conditions. Regional distribution of local PBF in dogs showed no statistical differences. Technical aspects of the HCT were described in detail. Under physiological conditions parenchymal trauma following electrode implantation was negligible in nearly all cases. More than 95% of registered clearance curves were monoexponential and showed excellent reproducibility of PBF values in repeated measurements (percentage deviation < or = 6.7). Five days after initiating biliary pancreatitis by common channel ligation in opossums local PBF was 72.1 +/- 14.7 after implantation of new electrodes. Chronically implanted electrodes, however, recorded only 39.7 +/- 15.8, due to massive fibro-proliferative alterations around the implanted electrode tips. We therefore conclude that the HCT as described is a useful tool for measuring local PBF in acute experimental settings only. Biliary pancreatitis in our model causes no significant alterations of PBF after 5 days.

C' and depression

Research assessing the validity of the Rorschach hypothesis that achromatic responses (C') reflect depressiveness was reviewed. The conclusions drawn from these data are that the research does not support the hypothesis as stated and research is needed to clarify the relationship of depressiveness to the determinants or the psychological meaning of C'. Until such time as objective signs of depression and depressiveness can be discovered by research, clinicians should not interpret C' as signifying depressiveness. If the search is for assistance in discerning depressiveness from the analysis of Rorschach data, until a more objective and valid method of such assessment is developed, the presence of depressive content would appear to be a satisfactory method of assessing a person's depressiveness.

Non-Hodgkin lymphomas of the central nervous system. Clinico-pathologic and immunohistochemical study of 147 cases

We report on data gathered from five European centres regarding 147 primary non-Hodgkin Lymphomas (NHLs) of the Central Nervous System (CNS) in HIV-negative patients. The results lead us to make the following considerations: i) there has been a significant and progressive increase in the frequency of observation of this pathology during the course of the last two decades; ii) the pathology lacks specific characteristic symptoms; iii) the radiological profile, as observed by CAT and/or MNR, most frequently corresponds to an isodense or slightly hyperdense lesion which has clear margins and is capable of assuming the contrast medium homogeneously; iv) the tumour most often has a single supratentorial localisation; v) high grade B-cell lymphomas account for 66% of the observations, low grade B-cell varieties being relatively rare and cases of T-cell derivation exceptional (6/147); vi) immunohistochemistry allows the differential diagnoses with respect to primitive or secondary non-lymphoid tumours, and provides confirmation of the histogenetic assessment made on morphological grounds; vii) the course of the disease is not significantly influenced by the histotype, the phenotype, the number of lesions present or the chemotherapy regimen, but rather by the employment of combined surgery and radio- or radiochemotherapy. This study represents the largest series of CNS NHLs so far reported, and as such, provides precise clinico-pathological indications which were only partially obtainable from the relatively small previously published series. Some concluding remarks are made as to the genesis of CNS NHLs, along with some practical suggestions for reaching a better understanding of their complex biology.

On the validity of hypotheses derived from the Rorschach: the relationship between shading and anxiety, update 1992

Research on the hypothesis that shading responses on the Rorschach reflect how people deal with their anxiety was reviewed. The research does not lend support to the hypothesis, but serious methodological and conceptual problems with this research make it difficult to assess the meaning of the results of these studies. The nature of needed research is discussed.

Spark erosion procedure: a method for extensive combined fixed and removable prosthodontic care

Restoration that uses a combination of fixed and removable partial dentures, which involves precision attachments and telescopic procedures, represents one of the highest levels of functional and esthetic therapy. In the past, these restorations were mostly made with high gold-content alloys. The dental spark erosion procedure offers a sophisticated method for using base metal alloys for these complex restorations. This procedure combines the functional and esthetic advantages of precision restorations with the advantageous properties of base metal alloys such as low thermal conductivity, high strength, and lower cost.

Sensitive detection of the activation state of blood coagulation in porcine DIC models by a new fibrin immunoassay

Elevated levels of soluble fibrin in plasma indicate that thrombin converts fibrinogen to fibrin without sufficient inhibitory control. Therefore, measurement of soluble fibrin (SF) in plasma may be considered as a laboratory test for intravascular coagulation. We have demonstrated that a new immunoassay for detection of SF in human plasma (Lill et al., Blood Coag Fibrinol 1993; 4: 97-102), based on a fibrin specific monoclonal antibody, also detects porcine SF with high sensitivity. Thrombin-dependent generation of SF in porcine plasma in vitro resulted in increased reactivity of the assay system, which was time and dose dependent. Dextran sulphate (DXS) and bacterial lipopolysaccharide (LPS) were used as stimuli in in vivo experiments in pigs. Plasma levels of SF increased steadily after intravenous administration of DXS (5 mg/kg for 1 h) to 38 +/- 7.8 micrograms/ml (mean +/- SEM) at 2 h, whereas LPS (2 micrograms/kg/h for 6 h) markedly increased plasma SF levels to over 120 micrograms/ml (at 6 h) after a lag phase of 2 h. In conclusion, this new immunoassay for human fibrin allows specific and sensitive detection of soluble fibrin in porcine plasma.

Use of the Rorschach with Hispanic Americans

The rationale for and overview of research on the performance of Hispanic Americans on the Rorschach was addressed. Recommendations for further research were made.

[Long-term follow-up of anti-tachycardia surgery in patients with ventricular tachycardia]

From March 1980 to May 1992 mapping guided surgery was performed in 132 patients with drug-refractory recurrent ventricular tachycardia. There were 121 patients (group I) with coronary disease and 11 patients (group II) had noncoronary ventricular tachycardia. Patients in group I underwent subendocardial resection and cryoablation was performed in group II patients. Perioperative mortality (< 30 days after surgery) was 8% (10/132 patients). During the mean follow-up of 41 +/- 24 months, 37/122 patients (30%) died, 35/111 patients in group I (32%) and 2/11 patients in group II (18%) (p = 0.29). In group I, sudden death occurred in 8/111 patients (7%) and cardiac death in 23/111 patients (21%); in group II, 1/11 patients (9%) died from sudden and 1/11 patients (9%) from cardiac death. Nonfatal recurrences occurred significantly more frequently in group II (6/11 patients, 55%) than in group I (16/111 patients, 14%) (p < 0.01). During the follow-up functional class of heart failure improved in 69 patients (57%), remained constant in 27 patients (22%) and decreased in the remaining 26 patients (21%). The surgical approach to control ventricular tachycardia has low rates of sudden death and nonfatal recurrences in patients with drug-refractory ischemic ventricular tachycardia. Patients with noncoronary disease had a high incidence of nonfatal ventricular tachycardia after surgery and should be considered for other therapeutic approaches in the future.

Ventricular tachycardia surgery in 1992: did the automatic defibrillator change this approach?

The role of ventricular tachycardia (VT) surgery has been changed since the automatic implantable cardioverter defibrillator (ICD) is available. We studied the follow-up of 131 patients who underwent mapping guided surgery due to recurrent VT refractory to antiarrhythmic drug treatment. There were 65 patients operated upon between 1980-1985 (group I) and 66 patients between 1986-1991 (group II). Ten patients (8%) died perioperatively (< 3 weeks after surgery) [7/65 patients, 11%, in group I and 3/66 patients, 5%, in group II (P = 0.15)]. During a mean follow-up of 41 +/- 24 months, 38 of 121 patients died (31%), significantly more patients in group I (24/58 patients, 41%) than in group II (14/63 patients, 22%) (P < 0.05). In group I, there was a higher incidence of sudden (7/58 patients, 12%) or cardiac death (15/58 patients, 26%) than in group II (sudden death 4/63 patients, 6%, cardiac death 7/63 patients, 11%) (P < 0.05). There was a similar incidence of VT recurrences between group I (9/65 patients, 14%) and group II (9/66 patients, 14%). Our data show that the indication for VT surgery has changed since the ICD is available because of better patient selection.

Is the hydrogen clearance technique a useful tool for measurements of pancreatic blood flow during acute experimental pancreatitis?

Changes of pancreatic blood flow (PBF) during acute pancreatitis (AP) have been under investigation by means of electromagnetic flowmeters, radioactive microspheres, isotope fractionation, radioactive gas clearance, and venous outflow techniques. All methods, however, have certain drawbacks, which make the application of other techniques desirable. In this study, the hydrogen clearance technique (HCT) was tested for the first time in a well-established foxhound model of AP. PBF, systemic blood pressure, and heart rate were monitored over 90 min after the onset of AP and 60 min after therapeutic infusion of Dextran-40 (10 ml/kg body wt). Our results fully agree with the data found by other techniques in this experimental model. Sixty-five of 73 electrodes implanted into the pancreas of eight foxhounds were found working. From 1,024 registered clearance curves, 876 were identified as monoexponential. In the other cases, and only then, we found either dislocation of the electrode tips (n = 6) or perielectrodal hemorrhage during histological examination (n = 4). We believe that the HCT is a feasible and reliable tool for measuring PBF in experimental settings like AP.

Immunoreactive dynorphin A-like material in extracted human hypothalamic-hypophysial plasma

Immunoreactive dynorphin A-like material (ir-dyn A) in human plasma was measured by a validated radioimmunoassay. In peripheral plasma extracts mean concentrations between 20 and 40 fmol/ml were determined in volunteers and in patients with pituitary adenomas. In this latter group superimposable levels were detected three days before and during transsphenoidal microsurgery. Interestingly, ir-dyn A levels evaluated in extracts of hypothalamic-hypophysial plasma obtained during surgery, just after tumor removal, were 4-5 times higher than in peripheral plasma. Reverse-phase high performance liquid chromatography (rp-HPLC) of extracts of peripheral plasma samples revealed two immunoreactive peaks. The major form had the same retention time of dyn A-(1-32); whereas a second, more lipophilic, peak eluted later and was not further characterized. In contrast, rp-HPLC analysis of extracts of plasma collected from the suprapituitary region displayed only one peak eluting in the position of synthetic dyn A-(1-17). The presence of dyn-related peptides in hypothalamic-hypophysial plasma supports the hypothesis that they may play a part in the regulation of hypothalamic and/or pituitary functions in humans.

Characterization of chlorophyll a/b proteins of photosystem I from Chlamydomonas reinhardtii

In this study we have isolated the chlorophyll a/b-binding proteins from a photosystem I preparation of the green alga Chlamydomonas reinhardtii and characterized them by N-terminal sequencing, fluorescence, and absorption spectroscopy and by immunochemical means. The results indicate that in this organism, the light-harvesting complex of photosystem I (LHCI) is composed of at least seven distinct polypeptides of which a minimum number of three are shown to bind chlorophyll a and b. Both sequence homology and immunological cross-reactivity with other chlorophyll-binding proteins suggest that all of the LHCI polypeptides bind pigments. Fractionation of LHCI by mildly denaturing methods showed that, in contrast to higher plants, the long wavelength fluorescence emission typical of LHCI (705 nm in C. reinhardtii) cannot be correlated with the presence of specific polypeptides, but rather with changes in the aggregation state of the LHCI components. Reconstitution of both high aggregation state and long wavelength fluorescence emission from components that do not show these characteristics confirm this hypothesis.