Biomedical subjects
Publications and source records attributed to M Speranza.
A case of male breast myofibroblastoma, personally observed, is described. Preoperative examinations have a limited diagnostic value. Only histological study, with immunohistochemical stain, allows to make a right diagnosis and to distinguish this tumor from other, benign or malignant mesenchymal neoplasms.
Ventral lateral hernias of the abdominal wall are rare. On the basis of their location we can classify them as follows: hernias of the aponeurosis of the transversus muscle, hernias of the rectal sheath and transmuscular hernias of the iliac region. In a group of 3134 hernias of the abdominal wall observed in a period of 16 years, 11 ventral lateral hernias have been encountered (0.3%). The diagnosis often presents great difficulties as the symptoms and the clinical findings are not typical. They must be differentiated from hematomas of the rectus sheath, abscess or intra-abdominal processes. Echography and Computed Tomography have an important role in their detection. Nevertheless in some patients the true diagnosis is reached only intraoperatively. The treatment generally consists in surgical correction by layer closure of the fascial or muscular defect. In selected cases the use of prosthetic material and video laparoscopic repair are indicated.
On the basis of 30 clinical observations, the authors discuss the clinical and diagnostic features of carcinoma of the gallbladder, which is observed just in an advanced stage in the most part of cases. They also confirm its often poor prognosis. To-day echography and computed tomography play an important role in the preoperative diagnosis.
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A condition of acute pulmonary edema was obtained experimentally in the dog, perfusing the lower lobe of the left lung by a roller pump with compatible canine plasma. The edema develops contemporarily to the increase of pressure in the pulmonary artery and the interstitial tissue: it diffuses principally in the interstitial tissue, while after clamping the pulmonary veins it is observed also inside the alveoli.
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Alexithymia is a multidimensional concept associating an emotional component focused on the difficulty in identifying and describing feelings and a cognitive one centred on the use of a concrete and poorly introspective way of thinking. Alexithymia can be assessed by self-assessment instruments and in particular by the 20 items version of the Toronto Alexithymia Scale (TAS-20). Depressive disorders have complex relationships with the construct of alexithymia and there exist few experimental works on the subject. Epidemiological studies frequently raise an overlap between alexithymia and depression, in particular in the context of addiction. The main aim of this study was to confirm the high prevalence of alexithymia among drug addicted patients taking into account socio-demographic variables (sex, age, social and economic categories). The second aim of the study was to investigate the relationships between alexithymia and depression among drug addicted patients. A sample of 128 drug addicted patients answering DSM IV criteria of dependence to a psycho-active substance (alcohol excluded) was paired according to socio-demographic variables to a control sample of 128 normal subjects. Diagnostic assessment was made using the Mini International Neuropsychiatric Interview (MINI). Alexithymia and depression were assessed with the TAS-20 and with the short version of the Beck Depression Inventory (BDI-13). The results confirm the high prevalence of alexithymia among drug addicted patients (43.5%) compared to controls (24.6%). This difference is based namely on the emotional component of alexithymia, the cognitive component failing to show any difference between the two samples. Moreover, alexithymia appears to be independent from socio-demographic variables in our sample of drug addicted patients; 66.4% of drug addicted patients presents a depressive symptomatology (which is significantly more important in female patients), compared to 26% of the controls. Studies using the TAS and the BDI with 21 items have shown that from 10 to 20% of the variance of alexithymia is explained by depression. Our own results show a shared variance of 20% between the TAS-20 and the BDI, going in the direction of a moderated correlation between alexithymia and depressive symptomatology. Moreover, when we retain only subjects without depressive symptomatology at BDI, drug addicted (n=42) are not any more alexithymic than controls (n=114). Our results plead for a positive association between depression and alexithymia in drug addicted, depressed or healthy subjects. Alexithymia and depression would be two associated dimensions, the emotional component explaining alone this association. The emotional component of the alexithymia would be thymo-dependent, whereas the cognitive component (externally oriented thought) would be independent and constitute a stable clinical feature. These results are concordant with other studies in the literature suggesting that alexithymia in its emotional component is supported by depression. Alexithymia thus did not appear as an autonomous dimension which would discriminate between drug addicted and controls, independently of the absence of a depressive state. The Authors discuss the complexity of the relationships between alexithymia and depression and the correlations between TAS and BDI scales especially for the factor Difficulty Identifying Feelings. These results deserve further studies. The cross-sectional nature of this study do not allow to establish if alexithymia is a subjacent and preexistent in the form of a psychopathological dimension in addictive behaviours, so supporting its emergence, and/or if it develops once the dependence is installed and chronicized. Longitudinal studies remain to be realised.
OBJECTIVE: Recent studies have indicated that the inflammatory cytokines could be implicated in anorexia nervosa and in its complications. To determinate the potential role of interleukins (IL-1, IL-2, IL-4, IL-6, IL-10), interferon (IFN gamma), tumor necrosis factor (TNF-alpha), and transforming growth factor (TGF-beta2) in anorexia nervosa, serum concentrations of these cytokines were measured in patients suffering from anorexia nervosa in comparison to healthy subjects. METHOD: Twenty-nine anorexic women according to DSM-IV criteria participated in the study. The control group consisted of 20 healthy women without eating disorders, mood disorders, and immunological disorders. RESULTS: We find that serum IL-2 and TGF-beta2 concentrations were both significantly decreased in anorexic patients, although the other cytokines did not differ significantly between the two groups. CONCLUSION: Our results show that in patients with anorexia nervosa, there are lower levels of specific cytokines (especially IL-2 and TGF-beta2). These levels may reflect the combination of impaired nutrition and weight loss, therefore, the dysregulation of these cytokines may contribute in anorexia's complications. Follow-up studies should examine the effects of parameters such as starvation, psychopathologic factors, and psychoneuroendocrinological perturbation which could affect interplay between cytokines, neuropeptides, and neurotransmitters.
UNLABELLED: A significant proportion of patients suffering from Eating Disorders (ED) present a comorbidity with anxiety disorders. Among the anxiety disorders, Obsessive Compulsive Disorders (OCD) are the third most frequently diagnosis observed in ED. However, prevalence rates from the literature are contradictory depending on the diagnostic criteria and evaluation tools used. Studies concerning the chronology of appearance of OCD and ED and the role played by denutrition are even rarer and equally contradictory. OBJECTIVE: The aim of this study is to bring new empirical data to the study of the correlations between OCD and ED by exploring, in a significant clinical sample, the current and lifetime OCD comorbidity in the diagnostic sub-groups and sub-types of ED as defined by the DSM IV and to study the chronology of appearance of these disorders taking into account the role played by denutrition. We make the assumption that there should be a difference in the prevalence of obsessive compulsive disorders in the various ED sub-groups and sub-types and that purging anorexics should, at equivalent levels of denutrition, exhibit higher OCD prevalence rates than the other sub-types as a result of their more severe general psychopathology. METHODS: Current and lifetime prevalence were investigated using the Mini International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive Compulsive Scale in a sample of 89 DSM IV eating disorders in and out-patients aged between 15 and 30 (58 AN and 31 BN) and 89 matched controls. In order to increase the validity of the current diagnosis of OCD only patients presenting an OCD diagnosis on the MINI (excluding obsessions and compulsions related to food and body image) and a score of 16 or more on the Y-BOCS were included in the study. RESULTS: Current and lifetime prevalence of OCD in ED is significantly higher than in general population (15.7% and 19% vs 0% and 1.1%, p < 0.05). Anorexic and bulimic patients do not show any difference in the current and lifetime comorbidity (19% and 22.4% vs 9.7% and 12.9%, ns). Concerning the diagnostic sub-types, following our assumption purging anorexics present the higher current and lifetime prevalences (29% and 43%), followed by restrictive anorexia (16%) and purging bulimia (13%). The only significant difference is found in the lifetime prevalence of OCD between purging and non purging anorexics. In the great majority of cases (65%) OCD diagnosis precedes ED diagnosis and OCD current prevalence and Y-BOCS scores of underweight patients are not significantly higher than normal weight patients, suggesting that there are only limited links between denutrition and obsessionality. LIMITS: Some methodological limitations must be considered. First of all, the small sample size of the diagnostic sub-types of ED do not enable us to draw definitive conclusions concerning the prevalence of OCD in the clinical forms of ED. Some of the diagnostic sub-types of ED, as BN-NP, appear at different ages: in order to better investigate the prevalence of OCD in all the diagnostic sub-types, larger age ranges should be considered. Secondly, our sample of anorexics is almost made of hospitalized inpatients recrutated in a specialized university unit, whereas bulimics are all consulting outpatients. It is possible that the higher than normal rates of OCD in anorexics could be related to the severity of this sample. Comparisons with samples of consulting anorexics should be performed. Lastly, it is necessary to evoke the limitation represented by the choice of a healthy control group. OCD are rare in the general population and the differences found between the clinical and the control groups do not offer strong arguments to support the specificity of the association between OCD and ED, which would be better explored by using a pathological control group. CONCLUSIONS: So far, none of the various models proposed to explain the comorbidity observed between ED and OCD appears completely satisfactory. ED and OCD would share a genetic vulnerability to a dysregulation of serotoninergic functioning which would predispose these subjects, depending on specific clinical and biological conditions, to develop an obsessional and compulsive symptomatology more or less focused on food and body image. The knowledge of the clinical and biological specificities of the ED diagnostic sub-types presenting an OCD comorbidity could point the way towards specific therapeutic interventions in these patients. Our study of the comorbidity of OCD in ED makes a further contribution to the identification of specific links between the OCD and the various clinical forms of ED. More clinical and biological studies are needed to further explore these relationships.
Sidney Blatt, considering as being insufficient the categorical-symptomatic approach of depression, has worked out a theory of depression and psychopathology that integrates the contributions of psychoanalysis as well as cognitive and developmental psychology. Within a broad psychoanalytic framework, Blatt's formulation focus on the quality of interpersonal relationship, the nature of object representation and early life experiences. Personality development is viewed as the consequence of the interaction of 2 basic developmental tasks: the establishment of the capacity to form stable, enduring, mutually satisfying interpersonal relationships and the achievement of a differentiated, realistic, essentially positive identity. The relationship between these 2 developmental lines involves a complex dialectical process during which progress in each line is essential for progress in the other and which contributes to the development of both a sense of identity and the capacity for interpersonal relatedness. These developmental lines permit not only to define an during individual's primary personality configuration but also enable to identify cognitive structures that are inherent in various forms of psychopathology, including depression. Disruptions at different developmental stages create vulnerability to different subsequent psychological disturbances. Blatt characterised as anaclitic or dependent the axis concerned with interpersonal relationship and as introjective or self-critical the axis concerned with development of the sense of self and identity. Depressive Experience Questionnaire was developed by Blatt et al. to determine the validity of this model of psychopathology which emphazises continuities between normal and pathological forms of depression. The instrument was developed by Blatt et al. by assembling a pool of items describing experiences frequently reported by depressed individual. Sixty-six items were selected and administered to a large nonclinical sample (500 female and 160 male undergraduates). Principal component analysis within sex performed on the answers to DEQ confirmed his assumption in identifying two principal depressive dimensions. The first factor involved items that are primarily externally directed and refer to a disturbance of interpersonal relationships (anaclitism); the second factor consists of items that are more internally directed and reflect concerns about self-identity (self-criticism). A third factor emerged, assessing the good functioning of subject and confidence in his resources and capacities (efficacy). Scales derived from these factors have high internal consistency and substantial test-retest reliability. The solutions for men and women were highly congruent. Factor structure has been replicated in several nonclinical and clinical samples, supporting considerable evidence to the construct validity of the DEQ Dependency and Self-criticism scales. An adolescent form of DEQ (DEQ-A) has successively been developed. Factor analysis revealed three factors that were highly congruent in female and male students and with the three factors of the original DEQ. The reliability, internal consistency and validity of DEQ-A indicate that the DEQ-A closely parallels the DEQ, especially in the articulation of Dependency and Self-criticism as two factors in depression. These formulations and clinical observations about the importance of differentiating a depression focused on issues of self-criticism from issues of dependency are consistent with the formulations of others theorists which, from very different theoretical perspectives, posit 2 types of depression, one in which either perceived loss or rejection in social relationships is central and the other in which perceived failure in achievement, guilt or lack of control serves as the precipitant of depression. These 2 types of experiences have been characterized as dominant other and dominant goal , as anxiously attached and compulsively self-reliant and as sociotropic and autonomous . Our work presents the results of a validation study of both forms of Blatt's questionnaire (for adults--DEQ--and for adolescents--DEQA) translated in French in a large population of normal subjects, aged 15 to 45 years. DEQ and DEQ-A were compared by inspection of items loading strongly on each factor and by correlation of the three factors of adults and adolescents. The exploratory factor analysis of DEQ and DEQA revealed three orthogonal factors, corresponding with Blatt's original dimensions. Consistency and external validity were adequate for all 3 factors of DEQ and DEQ-A. Anaclitism and self-criticism dimensions of DEQ and DEQ-A correlate positively with measures of depression (DSM-IV, Beck Depression Inventory), consistently with the results obtained by Blatt. Differently from this author, anaclitism appears to be less differentiated in males than in females, suggesting that the concept of dependence could assume different relevance for men and women.
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