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Received July 1, 2014; revised August 26, 2014; accepted August 26, 2014. From The Neuropsychiatry Program at Sheppard Pratt, Sheppard Pratt Health System, Baltimore, MD. Send correspondence and reprint requests to Margo Lauterbach, M.D., The Neuropsychiatry Program at Sheppard Pratt, Sheppard Pratt Health System, 6501 N. Charles Street, P.O. Box 6815, Baltimore, MD 21285-6815; e-mail: mlauterbach@sheppardpratt.org & 2015TheAcademy of PsychosomaticMedicine. Published by Elsevier Inc. All rights reserved. Introduction

Margo D Lauterbach,1 Paula L Notarangelo,1 Stephen J Nichols,2 Kristy S Lane,1 Vassilis E Koliatsos11The Neuropsychiatry Program at Sheppard Pratt, Sheppard Pratt Health System, Baltimore, MD, 2Department of Emergency Medicine, The University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USAAbstract: Traumatic brain injury (TBI) causes a variety of neuropsychiatric problems that pose diagnostic and treatment challenges for providers. In this report, we share our experience as a referral neuropsychiatry program to assist the general psychiatrist when adult TBI patients with psychiatric symptoms present for evaluation and treatment. We completed a retrospective study of patients with moderate-to-severe TBI and severe neuropsychiatric impairments. We collected information on demographics, nature of injury, symptomatology, diagnoses, and treatments. Data analysis indicates that mood stabilization was a key concern, often requiring aggressive pharmacological management. Cognitive dysfunction was a problem for the majority of patients, but was only medicated in a third, due to poor efficacy or behavioral side effects. The co-occurrence of multiple TBI-related symptoms and diagnoses in this patient cohort emphasizes the need for individualized psychopharmacological approaches and interventions.Keywords: traumatic brain injury, neurobehavioral, treatment

Approximately 19 years ago, Terhorst and colleagues ([1][1]) reported the cloning of the gene encoding a small adaptor protein, signaling lymphocyte activation molecule (SLAM)-associated protein (SAP), named by virtue of its binding to the intracellular tail of the cell surface receptor SLAM.

ANTINEOPLASTICTREATMENT HAVE SIGNIFICANTLY INCRESED THE SURVIVAL OF CANCER PATIENTS WHO, HOWEVER, RISSK PREMATURE MENOPAUSE. OOCYTE CRYOPRESERVATION HAS RECENTLY BEEN PROPOSED AS A FERTILITY- SAVING OPTION. THIS REPORT DESCRIBES THE FIRST LIVE BIRTH ACHIEVED WITH AUTOLOGOUS CRYOPRESERVED OOCYTES IN AN OVARIECTOMIZATED BOREDERLINE CANCER PATIENT.

We have analyzed the self-reactive repertoires of IgM and IgG Abs in the serum of 19 patients with hyper-IgM syndrome (HIM) by means of a quantitative immunoblotting technique that allows for a quantitative comparison of Ab repertoires in health and disease by multiparametric statistical analysis. Normal tissue extracts of liver, lung, stomach, and kidney were used as sources of self Ags. Extracts of Pseudomonas aeruginosa and Staphylococcus epidermidis were used as sources of nonself Ags. We demonstrate a significant bias in repertoires of reactivities of IgM of patients with HIM with self Ags. Ab repertoires of IgM toward nonself Ags did not differ, however, between patients and controls. No difference was found between IgM repertoires of untreated patients and those of patients receiving substitutive treatment with i.v. IgG. IgG in the serum of HIM patients lacked reactivity with self Ags, although it exhibited a pattern of reactivity with nonself Ags that was similar to that of IgG of healthy controls. The data demonstrate that functional CD40-CD40 ligand interactions are essential for the selection of natural self-reactive B cell repertoires.

Although relatively rare, acute pancreatitis is the most common disease complex involving the pancreas in the paediatric age group. The etiology of the disease is often unknown, and Italian epidemiological data on the paediatric population and, in particular, on the etiology of the disease are not available (except for studies of prevalence). Within the field of the most frequently encountered pancreatitis in the age range of our interest (i.e. 0-18 years), not only the commonly observed forms whose etiopathogenesis is ascribable to cholelithiasis must be mentioned but also those forms due to proteic-caloric malnutrition that are becoming increasingly common. The presenting clinical symptoms and signs may not be typical and the laboratory tests may not always be sensitive enough. In such age range chronic recurrent pancreatitis plays a very important epidemiologic role. Approximately 40% of children and teenagers admitted to the hospital with a diagnosis of pancreatitis report a previous episode of the disease. Irreversible changes in pancreatic parenchyma develop in those patients in whom the disease progresses, leading to pancreatic insufficiency. Such a morbid condition (chronic pancreatitis) is more often observed in adolescents, in whom the disease manifests itself with a vague repetitive dyspeptic symptomatology, after alternating remissions and recrudescences, not always clinically evident. In children, the clinical picture most commonly encountered is represented by recurrent abdominal pains, in view of the fact that the patients are frequently affected by thalassaemia. The pseudocystic evolution of the disease is the most common organic damage resulting from the chronic progression of the pancreatic impairment. A few differences have been found with respect to severity, etiology, and mortality of pancreatitis in the paediatric age group as compared with older age groups. Both the general practitioner with a paediatric practice and the paediatrician encounter a large number of difficulties in this field of pathology. Therefore, an adequate and correct "management" of children with acute or chronic pancreatitis seems to be mandatory.

To reaffirm the role of MRI in the assessment of the M#159;llerian duct anomalies (MDAs).Between November 1997 and April 2001, 22 patients, age range 18-40 years (mean 29 years) were investigated with MRI and US. The MRI study was performed with a 0,5 Tesla imager (Vectra, GE Medical System) with body-coil; neither oral nor intravenous contrast was used. We obtained SE T1-weighted, fast STIR with fat suppression and FSE T2-weighted sequences. Sagittal, paracoronal and paraxial images were acquired. The paraxial images were obtained to produce true coronal images of the uterus. In evaluating MDAs, imaging the uterus in its true coronal plane is essential to assess the external fundal contour. US examination was performed with an HDI 3000, ATL, using the trans-vaginal approach. The MDAs were subdivided according to the Buttram and Gibbons classification.There were 22 cases of laparoscopic and hysteroscopic proved anomalies; MRI allowed correct diagnosis of 21 uterine anomalies (accuracy, 95%) whereas U.S. was correct in 20 of 22 cases (accuracy, 92%). The MRI was excellent in depicting the uterine morphology in one case of unicornuate uterus with rudimentary horn non-comunicating with the main cavity and distended by hematometra and associated hematosalpinx. Further-more evaluating composition, thickness and extension of the uterine septum and aspect of the fundal contour, MRI allowed to differentiate definitively between bicornuate uterus and septate uterus. This is a very important distinction to do because it significantly affects patient treatment: a septate uterus requires hysteroscopic septectomy, while a bicornuate uterus does not requires surgical treatment.Given its characteristics, MRI is a very accurate imaging modality in uterine evaluation and contributes significantly to treatment planning. Although ultrasonography remains the modality of choice for the initial study of patients who are suspected of having a MDAs, we propose, in accordance with many authors in the literature, to reserve MRI imaging for patients with a technically inadequate or indeterminate ultrasound examination.

Wiskott-Aldrich syndrome (WAS) is an X-linked disorder characterized by congenital thrombocytopenia and progressive deterioration of the immune function. Dendritic cells (DC) are key effectors in the induction of specific immunity and are highly specialized in antigen uptake and subsequent migration to draining lymph nodes. DC were generated in vitro from circulating monocytes from ten WAS patients characterized by a different disease score. Immature DC showed similar morphology and membrane phenotype, as compared to normal DC. In chemotaxis assay, immature DC had a reduced migration in response to MIP-1alpha/CCL3, but efficiently endocytosed the macromolecules FITC-dextran and FITC-albumin. Upon terminal differentiation with LPS or CD40 ligand, the acquisition of a mature surface phenotype was variably achieved among WAS patients, with increased expression of CD80, CD86 and DC-LAMP. In contrast, the expression of CD83 was usually low. A defective up-regulation of CD83 was also observed in the lymph node from one WAS patient, whose DC stained positively for DC-LAMP. Mature DC from all the patients tested, but one, significantly migrated in vitro in response to MIP-3beta, a finding confirmed in vivo by the detection of HLA-DR/DC LAMP-positive cells in secondary lymphoid organs. When tested in MLR assays, both immature and mature WAS DC induced allogenic T cell proliferation in a manner comparable to control DC. Collectively these results suggest that, although many functional activities of WAS DC are essentially similar to normal DC, subtle and selective alterations of DC differentiation were also observed, with reduced migratory activity of immature DC and defective CD83 expression upon maturation.

SUMMARY Programmed death of T cells has been proposed as one of the mechanisms by which HIV induces a decline in the number and functions of T cells in advanced AIDS. In this study we report on a patient affected by a congenital form of combined immunodeficiency presenting as a profound T cell activation deficiency. Subsequently, a gradual loss of T cells occurred, eventually resulting in a classical form of severe combined immunodeficiency (SCID). In this patient a sizeable fraction of apoptotic cells was documented in the first phase of the disease by either propidium iodide staining or DNA fragmentation analysis. The presence of anergic T cells of maternal origin and engrafted in the child was excluded by analysis of DNA polymorphic regions. At 4 years of age the patient died of disseminated interstitial pneumopathy, while still awaiting an HLA-matched bone marrow transplantation. On the occasion of a new pregnancy in the mother, the prenatal immunological evaluation of the female fetus revealed a T− B+ SCID phenotype. This is the first observation of a primary immunodeficiency associated with inappropriate apoptosis.

L'articolo propone alcune riflessioni antropologiche allo scopo di mettere in luce l’infondatezza degli atteggiamenti essenzializzanti e dei processi di categorizzazione e di stereotipizzazione particolarmente evidenti nei confronti di chi è di religione musulmana, a partire da una ricerca etnografica effettuata a Genova presso un’associazione di giovani adulti migrati dal Marocco.