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BACKGROUND AND OBJECTIVE: Phantom limb pain (PLP) is a major problem after limb amputation. Mirror therapy (MT) is a non-pharmacological treatment using representations of movement, the efficacy of which in reducing PLP remains to be clarified. Here, we present the first systematic review on MT efficacy in PLP and phantom limb movement (PLM) in amputees (lower or upper limb). METHODS: A search on Medline, Cochrane Database and Embase, crossing the keywords "Phantom Limb" and "Mirror Therapy" found studies which were read and analyzed according the PRISMA statement. RESULTS: Twenty studies were selected, 12 on the subject of MT and PLP, 3 on MT and PLM, 5 on MT and both (PLP and PLM). Among these 20 studies, 5 were randomized controlled trials (163 patients), 6 prospective studies (55 patients), 9 case studies (40 patients) and methodologies were heterogeneous. Seventeen of the 18 studies reported the efficacy of MT on PLP, but with low levels of evidence. One randomized controlled trial did not show any significant effect of MT. As to the effect of MT on PLM, the 8 studies concerned reported effectiveness of MT: 4 with a low level of evidence and 4 with a high level of evidence. An alternative to visual illusion seems to be tactile or auditory stimulation. CONCLUSION: We cannot recommend MT as a first intention treatment in PLP. The level of evidence is insufficient. Further research is needed to assess the effect of MT on pain, prosthesis use, and body representation, and to standardize protocols.

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In order to test the impact of mothers' eating disorders (EDs) on their children's psychological adjustment, we recruited mothers belonging to three different populations: women with eating disorders, women with depression, and normal controls. The parents responded to self-report inventories relating to psychological adjustment of the parent and child. The study found that the psychological adjustment of the children of mothers with a history of ED was not different from that of the children of mothers in the normal control group, although mothers described significant pregnancy and birth complications, parenting stress, and symptoms of clinical depression. The children of mothers with a history of depression had significantly greater psychological problems in comparison with those of the children of mothers in the other two groups. The results are interpreted in the context of the protective factors that may have buffered the effects of maternal psychopathology in children of mothers with a history of ED.

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Three groups of women: eating disorder, body dysphoric controls, and nonsymptomatic controls, participated in an experiment testing hypotheses derived from cognitive-behavioral theories of eating disorders. In phase 1, participants encoded ambiguous information via instructions to imagine themselves in a variety of ambiguous situations that involved two types of information: body-related or health-related. On a subsequent memory task, participants in the eating disorder group and the body dysphoric control group recalled imagery of the body-related situations with a fatness interpretation and participants in the nonsymptomatic control group recalled imagery with a thinness interpretation. The three groups did not differ in their interpretation of the health-related situations. In phase 2, participants were instructed to imagine themselves in each body-related situation, but were explicitly instructed to imagine the scenes with either a positive or negative interpretation. Results indicated that the eating disorder and body dysphoric groups were able to change their interpretation of body-related information when instructed to do so.

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The purpose of this investigation was to develop a brief self-report inventory which could be used to evaluate treatment outcome for anorexia and bulimia nervosa. The Multifactorial Assessment of Eating Disorders Symptoms (MAEDS) was constructed to measure six symptom clusters which have been found to be central to the eating disorders: depression, binge eating, purgative behavior, fear of fatness, restrictive eating, and avoidance of forbidden foods. The factor structure of the MAEDS was found to be stable and it was found to have satisfactory reliability and validity. Normative data were collected so that raw scores could be converted to standardized scores. While still in the experimental stages, the MAEDS shows promise as a valid and economical measure of treatment interventions for anorexia and bulimia nervosa.

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In 1989, we reported our thoughts on the neurophysiological and anatomic aspects of pudendal nerve involvement in certain types of perinal pain. Since that time, the surgical approach has been modified. Here we report our follow-up of 40 patients with 48 operated nerves. Follow-up ranged from 6 months to 7 years and outcome revealed improvement in 67% and no change in 33%. Thus surgery had been useful in two-thirds of the cases; in 44% of the patients, there was either a frank improvement or no change. Early diagnosis appears to be the determining factor in improving results. Operating for the canal syndrome must be performed before lesions to the nervous trunk become too important.

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Ethanol may play an active role in modifying "set point" levels in conjunction with behavioral thermoregulation. A geometric series of doses of ethanol solutions was administered (ip) prior to fixed-interval 2-min. schedules of microwave reinforcement in rats tested in a cold environment. Four Sprague-Dawley rats were conditioned to regulate their thermal environment with 5-sec. exposures of MW reinforcement. Friedman's nonparametric test showed significant differences between ethanol doses, and Sign tests showed that moderate and high doses of ethanol suppressed operant behavior reinforced by MW radiation. Interactions between changes in "set-point" and discriminative properties of ethanol are discussed.

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This observation has been previously reported as a multifocal and recidivant desmoid tumor. The first time, the patient was operated on for a desmoid tumor situated on his left thigh. He was reoperated on fourteen years later for a recurrent tumor implanted on the same place and a new one on the right arm. Recently bilateral pulmonary tumors were discovered. As far as this evolution was concerned, its exceptional pattern induced a new analysis of the microscopic data and the diagnosis of fibrohistiocytic sarcoma was established. This observation suggest to the authors some comments about the difficulty of diagnosis and therapy of such soft tissue tumors.

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Pain is as old as mankind. It has a threshold beyond which nobody can escape it. Pain is a biological and physiological phenomenon, an integrated part of our body and ego. Will all our efforts eventually make it disappear? Is its disappearance desirable? Pain is one of the major expressions of sensation. It is integrated by the central structures and expressed as a behavior of avoidance or attenuation of the effects produced by the cause of pain. The study of this behavior and of the transmission of the pain message corresponds to the study of how to fight against this message, which means that it should logically lead to the treatment of pain.

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After having outlined the theories of cranial osteopathy (SUTHERLAND, KARNI, UPLEDGER, and, more recently, CLAUZADE and DARRAILLANS), the authors refute the latter point by point. "Primary respiration" is in fact a way of thinking, and the various bones making up the calvaria and base of the skull, which are solidly synostosed in the adult, are clearly incapable of the pretended rhythmic displacements "described" by the osteopaths. Moreover, the C.R.L., like any liquid, is incompressible and mildly pulsatile. Conversely, although the brain clearly shows rhythmic pulsations, which every neuro-surgeon notes every day, the latter are exclusively connected to the vascular system.

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The biomechanics-, engineering- and anatomy-oriented authors studied the craniofacial structures emphasizing their perfect adaptation to stresses developing during mastication or related to head statics and motions. For a better understanding of the biomechanics of the basis of the skull and face, attention is consistently drawn to solutions used in state-of-the-art engineering, such as aeronautics, in consideration that such solutions as are chosen by engineers are often--consciously or not--copied from nature.

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The authors studied the strains acting on a normal femur, and on the same femur fitted with an uncemented screwed prosthesis, by means of the method of holographic interferometry. This modern optical method has the advantage of not requiring any preparation of the surfaces or modification of the bone to be studied. It is non-destructive and can be repeated. This study required 40 interferograms for each case, using two or even three views. Comparison of the images obtained showed major modifications: disappearance of the physiologic flexion of the diaphysis, overload of the upper third, and zones of excess constraint.

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Using thick sections of the base of the skull and face their mechanical structure is viewed from the engineering aspect and the anatomic solutions evolved are compared with those selected by Aerospatiale engineers for the concept and development of the Airbus. It is concluded that the anterior and middle cranial fossae, together with the face, constitute an inseparable mechanical assembly each of whose component units participate in the rigidity of the others. Since this mechanical assembly must provide maximal rigidity for minimal weight, this suggests that aeronautical solutions should throw much light on the detail of construction of the skull and face. Indeed, the rigidity and lightness of the latter are obtained by means of solutions familiar in aeronautics: the reliance on thin-shelled beams with a honeycomb filling, the diploe analogous to a preconstrained composite or sandwich structure, a system of frames, struts and stiffeners, and the use of fillets at the sites of junction of struts.

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Technical alternatives in conservative proctocolectomy are presently investigated to improve the functional results of the operation. To avoid 2 difficult steps in the procedure, mucosectomy and transanal manual suturing, is of interest to retain the entire and canal and to reduce anal stretching duration. A new technique of stapled anastomosis is described: after full mobilization and eversion of the rectum, this latter is closed using a linear stapler and cut immediately above the anal canal; a 18 cm long J pouch is constructed and the anastomosis is stapled using the new premium EEA instrument*. Clinical experience begun in 1989 january, concerns 6 patients (2 U.C., 4 polyposis): at this time, 5 of these had their ileostomy closed, functional results being under evaluation. This method allows 1) to retain all the anal canal, 2) to avoid prolonged anal dilatation, 3) to perform a rapid and safe stapled anastomosis.

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Clinical observations in patients suffering from positional perineal pain have led us to performing an anatomical study of the pudendal nerve in order to demonstrate compression of this nerve trunk by elements likely to compress it in the sitting position. Thus we observed that the falciform process of the sacrotuberous ligament may act in this way. Besides helping us to understand the clinical symptoms, this anatomical study allowed choosing the technique we found most appropriate for the anatomical conditions observed out of the various neurophysiological examinations described in the literature. Lastly, we describe the surgical technique that allows releasing the trunk of the pudendal nerve under an operating microscope.

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The authors question whether strengthening beams and spans for the calvarium really exist and, if so, what are their exact anatomic counterparts and their exact function in the resistance of the calvarium. They opine that this function is of secondary importance except for the frontal and internal occipital pillars. The resistance of the calvarium must rather be attributed to its sandwich structure, with local bracing where the constraints are too severe. While they believe in the existence of such braces as the occipital pillars between the calvarium and the endochondral skull base, they prefer the concept of the mastoid pillars. The mastoid process is a structure with a thin shell and alveolar content, which has the advantage of giving the sternocleidomastoid and digastric muscles a bigger area of attachment to a light structure.

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The caudate lobe of the liver is an independent segment straddling the right and left lobes of the liver. It is divided into 2 parts, right and left, indicated externally by the caudate and papillary processes. It is now possible to unvestigate it by ultrasonography and computed tomography, allowing its surgical excision for tumoral disease of the superior biliary confluence.

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