MRI provides a noninvasive means to measure spinal CSF volume and demonstrates the anatomic basis of physiologic volume changes. This has important implications for spinal anesthesia.

No abstract

No abstract

We present a case of aortic and tricuspid native valve endocarditis in which Cardiobacterium valvarum was isolated from the blood culture of a 65-year-old man. Cardiobacterium valvarum is a fastidious, Gram-negative bacillus. The genus Cardiobacterium encompasses two speciesCardiobacterium valvarum and Cardiobacterium hominis. Although both species rarely feature as the aetiological agent of endocarditis, Cardiobacterium hominis has a higher incidence than Cardiobacterium valvarum. For this causative organism, we believe this is the first report of fatality prior to surgical intervention and the first clinical course to be complicated by cerebral vasculitis. Native valve endocarditis caused by Gram-negative bacilli is extremely rare and identification of isolates may require the use of reference laboratories with molecular identification techniques. Case reportA previously fit and well 65-year-old male was admitted with an 8 month history of intermittent back pain, worsening abdominal distension and non-specific symptoms of malaise, fatigue, slowed mobility and weight loss. He had not visited his general practitioner for over 30 years and had no known past medical or drug history. The patient was an occasional drinker and ex-smoker, having stopped 25 years previously. He had no history of recreational drug use. His dentition was extremely poor with widespread caries and gingivitis. He did not report any recent dental manipulation.At initial presentation, the patient had a temperature of 37.2 u C and a thin habitus and was pale. Blood pressure was 130/80 mmHg and his pulse was regular at 80 beats min 21 . On examination, a grade 4 harsh ejection systolic murmur and petechial rash over plantar areas of both feet were noted. During abdominal examination he was thought to have an expansile abdominal mass.Initial tests revealed a normal electrocardiogram and chest and abdominal radiographs. Laboratory results revealed a normocytic, normochromic anaemia [haemoglobin 10.9 g dl 21 (normal 13-18 g dl 21 ), mean corpuscular volume 92 fl (normal 76-96 fl)], total white blood cells 6.5610 9 l 21 (normal 4-11610 9 l 21 ) and normal clotting. C-reactive protein was raised at 34 mg l 21 (normal ,5) and showed an increasing trend throughout admission, peaking at 60 mg l 21 on day 13 of admission. He had renal failure with an elevated urea of 30.5 mmol l 21 (normal 2.5-6.7 mmol l 21 ), creatinine 278 mmol l 21 (normal 70-150 mmol l 21 ) and potassium 5.4 mmol l 21 (normal 3.5-5 mmol l 21 ). Sodium was 133 mmol l 21 (normal 135-145 mmol l 21 ).Urine and blood cultures were taken in the emergency department (bioMérieux BactT/Alert; aerobic and anaerobic bottles; one set of cultures). An urgent computerized tomography (CT) scan of the aorta was performed to investigate the expansile mass and lower back pain. This showed no abdominal aortic aneurysm. Incidentally, the CT scan revealed a massively dilated bladder with bilateral hydronephrosis, splenomegaly, renal cysts and pulmonary nodules with an appearance suggestive of an inflamm...

The concept of object relations has been shown to be relevant for the process and outcome of psychodynamic psychotherapies. However, little is known about its relevance for the psychotherapeutic treatment of depression. In this study, we explored the predictive value of object relational functioning (ORF) for the therapeutic alliance and outcome of short-term psychodynamic supportive psychotherapy in patients with mild to moderately severe depression. The ORF of 81 patients was rated by using the Developmental Profile. The overall maturity of ORF measured at baseline was higher in patients who showed a better treatment response. In multiple regression analysis, the adaptive level of individuation appeared to be specifically predictive of outcome. Patients with a recurrent depression showed less mature levels of ORF, lower adaptive levels and a higher score on the symbiotic level. No association was found between ORF and therapeutic alliance during treatment. In contrast to the single measure of alliance early in therapy, the growth of the alliance was related to outcome. The study indicated the relevance of ORF for depression and established that it is distinctive from the actual therapeutic alliance.