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List Of Editors

Jefferson Journal of Psychiatry

List of Editors for Jefferson Journal of Psychiatry Volume 3, Number 2, July 1985.

A Conserved Tissue-Specific Homeodomain-Less Isoform Of Meis1 Is Downregulated In Colorectal Cancer., Richard C Crist, Jacquelyn J Roth, Scott A Waldman, Arthur M Buchberg

Department of Microbiology and Immunology Faculty Papers

Colorectal cancer is one of the most common cancers in developed nations and is the result of both environmental and genetic factors. Many of the genetic lesions observed in colorectal cancer alter expression of homeobox genes, which encode homeodomain transcription factors. The MEIS1 homeobox gene is known to be involved in several hematological malignancies and solid tumors and recent evidence suggests that expression of the MEIS1 transcript is altered in colorectal cancer. Despite this potential connection, little is known about the role of the gene in the intestines. We probed murine gastrointestinal tissue samples with an N-terminal Meis1 antibody, revealing …

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor to the Jefferson Journal of Psychiatry.

The Double Blind Gordian Knot, John Matt Dorn, Md

Jefferson Journal of Psychiatry

Book Review of: DIFFERENTIAL THERAPEUTICS IN PSYCHIATRY: THE ARTAND SCIENCE OF TREATMENT SELECTIONA. Frances, M.D., J. Clarkin, Ph.D., & S. Perry, M.D.New York: Brunner/Mazel, 1984395 pp., $30.00

Problems With Separation In An Identical Twin, Henry A. Doenlen, Md

Jefferson Journal of Psychiatry

Introduction

During residency we learn to apply the theories of development to understand and help our patients. These theories are based upon the relationship between a single childand his parents as he struggles to separate and individuate. Identical twins have special problems in that not only do they have to separate from their parents, but also from each other.

The Importance Of Comprehensive Assessment Of The Sexually Abused Child, Luz N. Colon-De Marti, Md

Jefferson Journal of Psychiatry

In the past few years public awareness of sexual abuse of children has increased, together with the recognition of its social, physical, and psychological effects (I). We must emphasize our role as diagnosticians in doing a comprehensive assessment of the sexually abused child. It is our professional responsibility to assess the general psychological status of the child before and after sexual abuse.

The Use Of Art Therapy In A Patient With Chronic Schizophrenia, Robert Morrow, Md

Jefferson Journal of Psychiatry

The artistic drawings of psychiatric patients have been of increasing interest to mental health professionals over the last hundred years. In the 1870's Simon speculated on the relationship between the art of psychotics and their illnesses (1) . Freud and Jung made observations about the symbolism of art work. By the 1940's Naumberg developed a system of art therapy relying heavily on psychoanalytic theory that is now a therapeutic discipline in its own right (2).

In the inpatient milieu art therapy is commonly offered in conjunction with other therapies that make up the inpatient experience. The art therapist often shares …

Interaction Of The Opiate And Neuroendocrine Systems, Peter Demaria, Jr, Md

Jefferson Journal of Psychiatry

Opiates are known to produce various physiological effects. Our understanding of these effects has been greatly increased by the discovery of the opiate receptor and the endogenous opioid peptides. Recent investigation has demonstrated that three distinct receptor subtypes exist; their function is currently being actively investigated.

Intractable Alcoholism In A Patient With A Levine Shunt, Bruce Blumenthal, Ms, Howard Field, Md, Ed Gottheil, Md, Linda Guerra, Ma, Willis Maddrey, Md, Ron Serota, Md, Ellen Shaw, Md

Jefferson Journal of Psychiatry

Ellen Shaw. M.D., Fellow in Hepatology: Mr. J is a forty-six-year-old white male who was initially seen on the medical service in July 1982. At that time he presented with hepatic encephalopathy, jaundice, and ascites. A liver biopsy was performed, confirming the clinical diagnosis of alcoholic hepatitis superimposed on cirrhosis. Following discharge it was difficult to maintain Mr. J as an outpatient. He did not follow dietary restrictions or take diuretics as prescribed. Additionally he was unable to control his drinking. Finally about a year ago a Levine shunt was implanted in an effort to control his ascites. Subsequently he …

Caring For Survivors Of Sudden Death In The Emergency Ward, Jeffrey Sarnoff, Md

Jefferson Journal of Psychiatry

Frequently, emergency physicians have to interact with family and friends of persons who have died suddenly, often unexpectedly. These interactions are in complex ways difficult for both emergency ward (EW) staff and for survivors of sudden death. It may be that the way in which this crisis is managed will be a major determinant in how these survivors will remember the incident of sudden death, and how they will cope with it psychologically and physiologically.

Parental Bereavement Following The Death Of An Adult Child, Allan E. Crandell, Md

Jefferson Journal of Psychiatry

Introduction

To coin a title with the words "death" and "children" in it appears to me like the height of incongruity. Children are like definitions of life itself. They seem to bubble over and to foam with vitality. Life seems to be theirs, even the sickly and skinny ones, and death is the property of the old. Children have sparkling eyes and uncomplicated ways and innocence and a simplicity I envy. I am temporarily tempted to keep the little ones that way. I think of joining parents and educators who struggle to spare them from any ugliness in their world, …

On The Outskirts Of Babel, John Matt Dorn, Md

Jefferson Journal of Psychiatry

INTRODUCTION

I admit to a fondness for book lists that began on Wednesdays in the eighth grade, when feet perched imperiously on the table in the corner I would review with inordinate glee the list of recommended reading. What seemed to others an onerous and pedantic exercise was to me a treasure map that dissolved the walls of the school around me.

Munchausen’S Syndrome: Towards A Psychodynamic Understanding, Sharon Riser, Md

Jefferson Journal of Psychiatry

INTRODUCTION

The third edition of the Diagnostic and Statistical Manual of Mental Disorders cites two essential criteria for the diagnosis of chronic factitious disorder with physical symptoms, more poetically known as Munchauseri's Syndrome:

a) Plausible presentation of physical symptoms that are apparently under the individual's voluntary control to such a degree that there are multiple hospitalizations;

b) The individual's goal is apparently to assume the "patient " role and is not otherwise understandable in light of the individual's environmental circumstances(I).

Additionally noted is the frequent occurrence of a true physical illness entailing extensive hospital treatment during the childhood or adolescence …

Editor's Column, John Matt Dorn, Md, Chief Editor

Jefferson Journal of Psychiatry

Recently, an editor of The Jefferson Journal of Psychiatry remarked to me his regret that we don' t publish more original material. By this, I think he meant that the articles we publish do not break new ground, but tend to be compilations of existing ideas and beliefs. I think that he is right about this, and for a while I was disillusioned. On reflection, however, I think there may be some value in our project.

List Of Editors

Jefferson Journal of Psychiatry

List of Editors for Volume 3, Number 1 of the Jefferson Journal of Psychiatry, Jan 1985.

Treatment Of Cerebrospinal Fluid Leak During Spinal Cord Stimulator Implantation With Epidural Blood Patches, Farid Kia, Md, Linqiu Zhou, Md, Jason Berk, Md

Department of Rehabilitation Medicine Faculty Papers

Conclusion:

Our data is consistent with prior studies in demonstrating that the incidence of dural puncture and CSF leak with SCS procedures is rare. Based on our experiences, performing an epidural blood patch intra-operatively on the contra-lateral side under fluoroscopy could prevent PDPH. This treatment should especially be considered in patients undergoing SCS trials in order to accurately assess the level of pain reduction. Patients with prior spine surgeries might pose higher risks for dural puncture and more extensive pre-operative assessment could be beneficial.

Novel Irradiated Axial Rotational Flap Model In The Rodent, Adam J. Luginbuhl, Mara Modest, Bs, Kaiguo Yan, Joseph Curry, Ryan N. Heffelfinger

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Abstract

Objectives: To design an easily reproducible rodent rotational skin flap and to evaluate the effects of radiation on flap viability.

Methods: Ten rats received 40 Gy irradiation to the abdominal wall. Following a recovery period of one month, a 3 X 8 cm fasciocutaneous flap based axially on the inferior epigastric vessel, was raised and rotated 60 degrees into a contralateral deficit. Five non-irradiated rats underwent the identical procedure as a control. Animals were sacrificed seven days postoperatively, areas of flap necrosis were documented, and histological specimens were taken to compare flap viability and vessel density.

Results: 60% of …

Growth Inhibition Of Human Hepatocellular Carcinoma Cells By Overexpression Of G Protein-Coupled Receptor Kinase 2, Zhengyu Wei, Reginald Hurtt, Cataldo Doria

Department of Surgery Faculty Papers

Summary:

In this study, we investigated a novel approach for HCC treatment by inducing overexpression of GRK2 in human HCC cells. We found that overexpression of GRK2 through recombinant adenovirus transduction inhibits the growth of human HCC cells. BrdU incorporation assay showed that the growth inhibition caused by elevated GRK2 level was due tot he reduced cell proliferation but not apoptosis. To examine the anti-proliferative function of increased GRK2 level, we performed cell cycle analysis using propidium iodide staining. We found that the proliferation suppression was associated with G2/M phase cell cycle arrest by the wild type GRK2 but not …

Assessment Of Adherence To Guidelines For Hepatocellular Carcinoma Screening In Hiv/Hcv Coinfected Patients, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. Self-reported adherence with published guidelines for HCC screening is poor among primary providers for HIV/HCV coinfected patients, including HIV specialists and University-based providers.

2. Unnecessary imaging is also frequently ordered on non-cirrhotics, particularly by University-based providers.

3. Improved adherence to guidelines is needed among primary providers as over 50% of HCC's may be missed, and many patients many not be referred for subspecialty GI or Liver care, where screening practices may differ.

Performance Of Colorectal Cancer Screening Steps In Primary Care, Salini Mohanty, Mph, Mona Sarfaty, Md, Mph, Faafp, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Discussion:

This analysis revealed the differences in which physicians in primary care complete CRC screening steps. The approach and completion of screening steps varied greatly among practices.

There was a correlation between the quantitative data and the qualitative data. The analysis from both methodologies produced similar results and supports each other's assessment.

All of the practices analyzed possessed one of the essential elements (a physician recommendation) which is the foundation for increased screening. All of the practices have the potential to expand upon this foundation in order to ensure that all eligible patients are approached and screened for CRC.

The …

Utilizing Livers From Donors Older Than 65: A Single Center Experience, Krishnaraj Mahendraraj, Jorge H. Castro, Sean Devitt, Chad Gorn, Cataldo Doria, Adam Frank, Warren Maley, Carlo G. Ramirez

Department of Surgery Faculty Papers

Conclusions:

Use of liver grafts from older donors presents similar survival outcomes as grafts from younger donor age. Therefore, it offers a viable option to expand the donor pool and increase number of OLTs.

However, there is higher incidence of retransplantation due to primary graft non-function, and longer hospital length of stay observed in the older donor age group.

Further studies using larger patient populations are needed to validate our results.

Classification And Treatment Of Proximal Humerus Fractures: Inter-Observer Reliability And Agreement Across Imaging Modalities And Experience., Abtin Foroohar, Rick Tosti, John M Richmond, John P Gaughan, Asif M Ilyas

Rothman Institute Papers

SUMMARY: Proximal humerus fractures (PHF) are common injuries, but previous studies have documented poor inter-observer reliability in fracture classification. This disparity has been attributed to multiple variables including poor imaging studies and inadequate surgeon experience. The purpose of this study is to evaluate whether inter-observer agreement can be improved with the application of multiple imaging modalities including X-ray, CT, and 3D CT reconstructions, stratified by physician experience, for both classification and treatment of PHFs.

METHODS: Inter-observer agreement was measured for classification and treatment of PHFs. A total of sixteen fractures were imaged by plain X-ray (scapular AP and lateral), CT …

Letters To The Editor

Jefferson Journal of Psychiatry

We welcome all letters to the editor, and encourage authors to reply. Input from residents and faculty on ideas presented in the Journal create the arena for discussion and dialogue which is the ultimate purpose of this undertaking.

Therapeutic Guitar-An Alternative Approach To The Treatment Of A Difficult Patient, Michael Buxbaum, Md

Jefferson Journal of Psychiatry

The case described in this article is one where an experimental technique was introduced largely because of the therapist's dissatisfaction with the patient's progress. Despite the likelihood of being criticized, I feel compelled to write about this patient. The progress he has made is beyond my expectations, which were admittedly minimal at the outset.

Misuses Of Computers By Adolescents, Henry A. Doenlen, M.D.

Jefferson Journal of Psychiatry

One subject that has been a topic of much recent publicity and concern has been that of computer misuse. Teenage computer programmers gaining entry into the systems of universities, hospitals and businesses have caused the most concern . The duplication of copyrighted programs and information has also been reported to cause loss of considerable money. There seems to be a subpopulation of people who spend considerable time working with computers. These individuals may do so to the exclusion of other aspects of life such as human interaction . This paper will present both my observations of this behavior and my …

The Treatment Of A Borderline Patient Complicated By Involvement With A Charismatic Religious Cult: A Case Report, Mark Miller, Md

Jefferson Journal of Psychiatry

Introduction

Although much has been written about cults in recent years, many questions remain. Do cults recruit subjects by brainw ashing them or do individuals gravitate to cults to fulfill unmet needs? This paper will review some essential points of cult phenomena and discuss the treatment of one patient who was involved in a charismatic religious cult .

Possible Synergistic Action Between Carbamazepine And Lithium Carbonate In The Treatment Of A Manic Patient., John Matt Dorn, M.D.

Jefferson Journal of Psychiatry

Introduction

Carbamazepine has been proven to be efficacious in some patients with affective disorders, notably those who have not responded well to lithium carbonate or neuroleptics (1,2,3) . For those who have responded poorly to either regimen, however, there have been no effective pharmacotherapies until recently, when case reports have suggested a possible synergistic action between lithium carbonate and carbamazepine (4,5,6). The following case report supports this hypothesis.

The Use Of Carbamazepine (Tegretol) In Psychiatry And Its Association To Kindling, Temporal Lobe Epilepsy And Psychopathology, James Stanch, M.D.

Jefferson Journal of Psychiatry

The recent theory of kindling may help to link neurophysiologic, neurotransmitter and neuroanatomic mechanisms important in understanding the neurology of behavior. Limbic kindling is of interest in developing models of epilepsy, psychosis, learning and memory (l -5). Kindling might explain the late development of psychopathology.

This paper will first define kindling and demonstrate how kindling offers a model within which to view more prolonged behavioral deviations as neurophysiological processes. The use of carbamazepine and its association to kindling, temporal lobe dysfunction and psychopathology will be discussed .

Discussion Of The Paper By David A. Scola, M.D. On “The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles”, Howard Field, M.D., Paul J. Fink, M.D., Thomas Swirsky-Sacchetti, Ph.D.

Jefferson Journal of Psychiatry

Dr. Scola proposes a bold and far-reaching synthesis of psychoanalytic theory, developmental neurobiology and neurophysiology of behavior. Freud found this task so frustrating in 1895 that he renounced neurology in favor of a purely psychologic approach (or so Freud claimed; Frank Sulloway sees it differently). Hypotheses that unconscious mental life is situated in the right cerebrum and that defense mechanisms are related to neuroanatomic connections are intriguing. The presentation does not include evidence which contravenes these theories. Sperry presented some evidence that the right hemisphere is self-aware and self-evaluative (I). One great problem in all cross disciplinary studies is the …

The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles, David A. Scola, M.D.

Jefferson Journal of Psychiatry

Volumes of research have been accumulated over the past decade concerning hemispheric specialization of the human brain. Likewise, over the past century, psychoanalysts have painstakingly unraveled through their clinical observation many of the mysteries of intrapsychic functions. Yet little has been written concerning attempts to integrate these seemingly divergent viewpoints.

It was Freud's hope that a neural basis for his clinical observations and psychological explanations of the human mind would eventually be established . This was not possible in his day, however, so this idea was gradually abandoned. With the advent of computers and high technology, perhaps it is time …