Chronic diarrhea associated with persistent norovirus excretion in patients with chronic lymphocytic leukemia: report of two cases

BACKGROUND: Chronic diarrhea in patients treated with immunosuppressive agents or suffering from immunosuppressive disease can represent a diagnostic and therapeutic challenge to the clinician. Norovirus infection, a major cause of acute epidemic diarrhea, has been described as a cause of chronic diarrhea in patients who are immunosuppressed, including transplant recipients and the very young. CASE PRESENTATIONS: We describe two patients, a 64 year-old man and a 59 year-old woman, both suffering from chronic lymphocytic leukemia and hypogammaglobulinemia, who developed chronic diarrhea resistant to therapy. In both cases, after months of symptoms, persistent norovirus infection--documented by repeatedly-positive high-sensitivity stool enzyme immunoassay--was found to be the cause. Both patients died with active diarrheal symptoms. CONCLUSIONS: We describe the first cases of advanced chronic lymphocytic leukemia to suffer from chronic symptomatic norovirus infection. Clinicians caring for such patients, particularly those with concomitant hypogammaglobulinema, who have chronic unexplained diarrhea, should consider norovirus infection in the differential diagnosis

Psychotherapy in historical perspective

This article will briefly explore some of the ways in which the past has been used as a means to talk about psychotherapy as a practice and as a profession, its impact on individuals and society, and the ethical debates at stake. It will show how, despite the multiple and competing claims about psychotherapy’s history and its meanings, historians themselves have, to a large degree, not attended to the intellectual and cultural development of many therapeutic approaches. This absence has the potential consequence of implying that therapies have emerged as value-free techniques, outside of a social, economic and political context. The relative neglect of psychotherapy, by contrast with the attention historians have paid to other professions, particularly psychiatry, has also underplayed its societal impact. This article will foreground some of the instances where psychotherapy has become an object of emerging historical interest, including the new research that forms the substance of this special issue of History of the Human Sciences

Introduction : narcissism, melancholia and the subject of community.

Sigmund Freud’s twin papers, ‘On Narcissism: An Introduction’ (1914) and ‘Mourning and Melancholia’ (1917 [1915]), take as their formative concern the difficulty of setting apart the ‘inner’ and the ‘outer’ worlds, and of preserving a stable image of a boundaried self. Whilst it is true that the term narcissism especially has come to be deployed in ways that seem foreign to the complexities of Freud’s 1914 paper (by its reduction to a personality disorder or its use as a broad-brush cultural diagnosis), we suggest in this introductory chapter that neither narcissism nor melancholia can be thought about today without expressing some debt to Freudian metapsychology. However, whereas Freud was most evidently concerned to describe the structure of ego-formation, subsequent commentators have preferred to emphasize the cultural and normative dimensions of these terms. Accordingly, we consider the respective discursive histories of narcissism and melancholia and find that although they have been put to work in very different ways they remain grounded by a shared concern with mechanisms of relation and identification. Indeed, this shared concern is the basis upon which they’ve been most productively reanimated in recent years: the rise of melancholia as a critical aid to the study of cultural displacement and dispossession, and the determined redemption of narcissism from its pejorative characterization as fundamentally anti-social. We argue that what is most noteworthy in this post-Freudian literature is the increasing relevance of metapsychology to social and political theory. The language of psychoanalysis, extrapolated from the clinic, permits a detailed examination of the boundaries which construct and challenge the terms of social solidarity. Specifically, this takes place though careful reading of the complex practices of (dis)identification at the heart of ego-formation (at both individual and group levels), and the associated mechanisms of defence, for example: introjection, incorporation, projective-identification, and splitting. By recognising the complexity of how communities get made, and connecting this with recent literature on counter publics and the commons, we demonstrate that Freud’s frameworks of narcissism and melancholia remain essential for any contemporary understanding of political association

Weight change during chemotherapy changes the prognosis in non metastatic breast cancer for the worse

<p>Abstract</p> <p>Background</p> <p>Weight change during chemotherapy is reported to be associated with a worse prognosis in breast cancer patients, both with weight gain and weight loss. However, most studies were conducted prior to the common use of anthracycline-base chemotherapy and on North American populations with a mean BMI classified as overweight. Our study was aimed to evaluate the prognostic value of weight change during anthracycline-based chemotherapy on non metastatic breast cancer (European population) with a long term follow-up.</p> <p>Methods</p> <p>Patients included 111 women diagnosed with early stage breast cancer and locally advanced breast cancer who have been treated by anthracycline-based chemotherapy regimen between 1976 and 1989. The relative percent weight variation (WV) between baseline and postchemotherapy treatment was calculated and categorized into either weight change (WV > 5%) or stable (WV < 5%). The median follow-up was 20.4 years [19.4 - 27.6]. Cox proportional hazard models were used to evaluate any potential association of weight change and known prognostic factors with the time to recurrence and overall survival.</p> <p>Results</p> <p>Baseline BMI was 24.4 kg/m2 [17.1 - 40.5]. During chemotherapy treatment, 31% of patients presented a notable weight variation which was greater than 5% of their initial weight.</p> <p>In multivariate analyses, weight change (> 5%) was positively associated with an increased risk of both recurrence (RR 2.28; 95% CI: 1.29-4.03) and death (RR 2.11; 95% CI: 1.21-3.66).</p> <p>Conclusions</p> <p>Our results suggest that weight change during breast-cancer chemotherapy treatment may be related to poorer prognosis with higher reccurence and higher mortality in comparison to women who maintained their weight.</p

A Learning Networks approach to resolve conservation challenges in the Ngorongoro Conservation Area

Conservation Biolog

Triple-A syndrome with prominent ophthalmic features and a novel mutation in the AAAS gene: a case report.

Triple-A syndrome (Allgrove syndrome) is an autosomal recessive disorder characterized by adrenal insufficiency, alacrima, achalasia, and - occasionally - autonomic instability. Mutations have been found in the AAAS gene on 12q13