Remarkable Recoveries Research Articles

Reversible infantile mitochondrial diseases.

Mitochondrial diseases are usually severe and progressive conditions; however, there are rare forms that show remarkable spontaneous recoveries. Two homoplasmic mitochondrial tRNA mutations (m.14674T>C/G in mt-tRNA(Glu)) have been reported to cause severe infantile mitochondrial myopathy in the first months of life. If these patients survive the first year of life by extensive life-sustaining measures they usually recover and develop normally. Another mitochondrial disease due to deficiency of the 5-methylaminomethyl-2-thiouridylate methyltransferase (TRMU) causes severe liver failure in infancy, but similar to the reversible mitochondrial myopathy, within the first year of life these infants may also recover completely. Partial recovery has been noted in some other rare forms of mitochondrial disease due to deficiency of mitochondrial tRNA synthetases and mitochondrial tRNA modifying enzymes. Here we summarize the clinical presentation of these unique reversible mitochondrial diseases and discuss potential molecular mechanisms behind the reversibility. Understanding these mechanisms may provide the key to treatments of potential broader relevance in mitochondrial disease, where for the majority of the patients no effective treatment is currently available.

Soil Flooding Tolerance in Lentil at Vegetative Stage

The experiment compared the relative tolerance of some advanced lines and a variety of lentil viz. BD3859, BD3905, BD3867, ILL5087, ILL5133 and BINAmasur1 (variety) to soil flooding. The growth rates of the genotypes considerably reduced when flooding imposed at vegetative stage. However, the genotypes responded differently to flooding onward during recovery period. Leaf and roots showed highly vulnerable to flooding. Flooding promoted extensive leaf senescence and desiccation. Flooding induced damaging of root system was highly striking, despite there existed remarkable recoveries in some genotypes. The adverse effect of flooding was less pronounced on stem than other plant components. However, shoot growth reduction was 76-86% relative to control. Relative growth rate (RGR) of most plant components showed negative rate during flooding, but it varied from negative to positive during recovery period. Considering total plant biomass, flooding tolerance (FT) indices indicated that BINAmasur1 and BD3859 had comparatively better degree of tolerance to excess water. In contrast, ILL5133 and ILL5087 were susceptible to flooding for having negative FT indices.DOI: http://dx.doi.org/10.3329/pa.v18i2.17460 Progress. Agric. 18(2): 17 - 24, 2007

Recovery Trends in Marine Mammal Populations

Marine mammals have greatly benefitted from a shift from resource exploitation towards conservation. Often lauded as symbols of conservation success, some marine mammal populations have shown remarkable recoveries after severe depletions. Others have remained at low abundance levels, continued to decline, or become extinct or extirpated. Here we provide a quantitative assessment of (1) publicly available population-level abundance data for marine mammals worldwide, (2) abundance trends and recovery status, and (3) historic population decline and recent recovery. We compiled 182 population abundance time series for 47 species and identified major data gaps. In order to compare across the largest possible set of time series with varying data quality, quantity and frequency, we considered an increase in population abundance as evidence of recovery. Using robust log-linear regression over three generations, we were able to classify abundance trends for 92 spatially non-overlapping populations as Significantly Increasing (42%), Significantly Decreasing (10%), Non-Significant Change (28%) and Unknown (20%). Our results were comparable to IUCN classifications for equivalent species. Among different groupings, pinnipeds and other marine mammals (sirenians, polar bears and otters) showed the highest proportion of recovering populations, likely benefiting from relatively fast life histories and nearshore habitats that provided visibility and protective management measures. Recovery was less frequent among cetaceans, but more common in coastal than offshore populations. For marine mammals with available historical abundance estimates (n = 47), larger historical population declines were associated with low or variable recent recoveries so far. Overall, our results show that many formerly depleted marine mammal populations are recovering. However, data-deficient populations and those with decreasing and non-significant trends require attention. In particular, increased study of populations with major data gaps, including offshore small cetaceans, cryptic species, and marine mammals in low latitudes and developing nations, is needed to better understand the status of marine mammal populations worldwide.

Clinical Detoxification: Elimination of Persistent Toxicants from the Human Body

Clinical Detoxification: Elimination of Persistent Toxicants from the Human Body

E-041 Subacute endovascular recanalization of supraclinoid internal carotid artery occlusions

PurposeManaging subacute or chronic cervical/intracranial thromboembolic occlusions can be challenging. With respect to the COSS trial, when medical treatment fails and ischemic symptoms persists, surgical bypass procedures may be considered...

Administration of edaravone, a free radical scavenger, during t-PA infusion can enhance early recanalization in acute stroke patients — A preliminary study

Background and purpose The aim of the present study was to investigate whether administration of edaravone during t-PA infusion can enhance early recanalization in acute stroke patients. Methods This trial was undertaken as a multicenter, single blind, randomized, open-labeled study. Acute stroke patients with M1 or M2 occlusion within 3 h of onset were studied prospectively. The subjects were randomly allocated to edaravone (Edaravone group: when t-PA was intravenously infused, intravenous edaravone (30 mg) was started at the same time) and no edaravone (Non-Edaravone group). Early recanalization within 1 h after t-PA infusion and neurological recovery 24 h after t-PA infusion were compared between the two groups. Results 40 patients (23 men, 17 women; mean age, 76.4 ± 8.2 years, median 79 years) were enrolled; 23 patients were assigned to the Edaravone group and 17 to the Non-Edaravone group. Early recanalization was more frequently observed in the Edaravone group than in the Non-Edaravone group (56.5% vs. 11.8%, P = 0.0072). Eight patients who underwent endovascular therapy immediately after t-PA infusion were excluded, and neurological recovery was analyzed. Remarkable and good recoveries were more frequently observed in the Edaravone group than in the Non-Edaravone group (80.1% vs. 45.5%, P = 0.0396). Conclusion Early recanalization and good neurological recovery were more frequently observed in the Edaravone group than in the Non-Edaravone group. These results demonstrate that administration of edaravone during t-PA infusion should enhance early recanalization in acute stroke patients.

Journaling and the Creative Writing Workshop in Counseling and Recovery of Adult Participants

BackgroundI discuss a method of facilitation that I have used in my Creative Writing courses at the University of Lethbridge for many years. I tend to focus primarily on potentials and possibilities in third-year courses and then move on to questions of forms, genre, and structure in the “Advanced” or exit-year courses. These courses rely heavily on rapport and a specific structure which has the effect (most of the time) of opening the spigot of the students’ creative energies. Purpose of Study. Data from this pedagogy is plotted in a qualitative exploration using in-depth phenomenological “prompts” or thought experiments. This data will be presented in order to depict how art making or (in this case, Creative Writing journaling) contributes to mental health recovery and stability. The hope of our team is that this method may be deploy at a downtown satellite program open to street people and all and any who seek help. Sources of Evidence. An interpretative phenomenological approach is applied to data collected in several years of Creative Writing workshops at the University of Lethbridge. This data is broken down into three main categories: explanatory models of how the skills, qualities and approaches of the facilitator assisted recovery, on transformative characteristics of art making in this particular venue, and the wider social benefits of such art making. Main Argument. Using collaborative techniques grounded on the premise that the workshop is unconditionally a “safe place”, a progressive conversation is established in which the matter of the self is drawn into both language that is fresh and control of language that holistically conforms to the group dynamic. In this dynamic, remarkable recoveries may take place. I will focus the discussion on the structure of the collaborative journalizing, the purpose of which is to bring structure into the very production of personal and creative recovery. The journaling is an extended process-meditation, begun on the first day of a half-semester course and finished on the day a final portfolio is submitted for grading. I argue that the dream-journaling should have a basic structure in any case, and discuss several such schema as they have been used not only in Creative Writing but also in the community and in the literature of counselling and guidance. Conclusions. The findings provide a initial but profound exploration into art facilitators’ pragmatic knowledge and wisdom related to the health and recovery benefits of art making in the area of counselling and guidance. It also explores important skills and competencies required by those facilitating art making programs in mental health recovery contexts. Such data may help to inform policy and design of health recovery programs associated with Creative Writing workshops both in the college or university setting as well as the community health unit.

Management of Traumatic Brain Injury

Traumatic brain injury (TBI) is a complex disease process that requires constant attention as one manages the associated body systems. Even though an "isolated" brain injury may be the cause for admission to the hospital, the injured brain cannot be thought of in isolation from the remainder of the body. All body systems, from cardiac to pulmonary, need to be addressed as one moves from the initial to the long-term management of the TBI. The multiple issues are best addressed with a dedicated neurocritical care team that is in continuous communication with the neurosurgical team throughout the course of treatment. To date, no pharmacologic treatment has led to improved outcomes after TBI, but it is becoming increasingly clear that advances in the critical care of TBI patients are contributing to better results.During resuscitation of the TBI patient, medical management in its simplest form strives to return measurable vital signs and laboratory values (eg, intracranial pressure, mean arterial pressure, blood glucose, PaO(2), or PaCO(2)) to their normal range. The initial goal is to maintain or reestablish normal homeostasis.The initial injury to the brain is irreversible by any medical modalities available today. After the initial resuscitation, medical maneuvers are directed at limiting secondary damage to the brain. Secondary brain injury occurs in response to inflammatory changes, expanding hematomas, cellular swelling, seizures, and systemic complications (ie, hemodynamic or pulmonary changes, fever, pain); vulnerable surrounding brain tissue can be damaged through alterations in cerebral perfusion and metabolism. Treatments to address these issues include, but are not limited to, analgesics, sedatives, anticonvulsants, hyperosmotic agents, and hypothermia.The future of TBI care likely lies in the areas of better injury classification to guide therapeutic interventions, management of secondary injury, improved technology for intracranial monitoring, and regeneration/rehabilitation. Studies focusing on signaling pathways, neural stem cells, and reparative medications are all in the early stages of development; their use is currently experimental at best.There are few areas in medicine where clinicians have the opportunity to impact a patient's life to the degree seen in the management of TBI. Although parts of the proverbial puzzle certainly remain unsolved, it is the remarkable recoveries that patients make with the therapeutic modalities available today that keep management of TBI one of the most exciting areas in medicine.

Treatment of childhood glial tumors with cisplatin and irinotecan

10062 Background: Childhood glial tumors are heterogeneous neoplasias for which non-surgical management is controversial. After a pilot study suggesting that irinotecan/cisplatin (I/C) may be effective in children (Mora et al, Neuro Oncol 2007), we initiated a phase II prospective trial with the aim of avoiding radiation therapy for low grade's (LG) and improve outcome for high grade's (HG). Methods: The indication for adjuvant therapy was based upon histology, the extent of surgical resection, and the presence of clinical or neuroradiological signs of progression. Weekly Irinotecan (50 mg/m2 and 65 mg/m2 the last 2 cycles) and Cisplatin (30 mg/m2) for four consecutive weeks (1 cycle), and a total of 4 cycles was used. Results: From January 2004 to December 2007, 30 children aged 6 months to 17 years were treated, 21 at diagnosis, 7 at progression and 2 at relapse. Fourteen tumors were WHO grades I-II gliomas (LGG), 10 grade III (6 gliomas, 2 anaplastic ependymomas and 2 AT/RT), and 6 had no biopsy (3 brainstem (BST) and 3 optic-pathway tumors (OPT)). Two patients had type-1 neurofibromatosis and OPT. Primary sites included: 4 supratentorial, 8 BST, 9 OPT, 2 cerebellar, and 7 spinal. Prior to the I/C regimen, gross total resection was performed in 7 and biopsy in 14 tumors; 9 patients received chemotherapy and 5 radiotherapy. All but 6 patients, 2 because of C allergy and 4 BST because of progression, completed the protocol, with no grade 3–4 side effects. Vomiting was the main side effect. Twenty (90%) of 22 patients with evaluable clinical symptoms had a complete and rapid response, with objective functional recovery. With a median follow-up of 25 months, 14 (47%) patients had a complete/partial response (7 out of 10 HG), 10 (40%) had stable disease (8 out of 14 LG), and 6 (20%) progressed (all BST). Five patients died of disease, all BST. Twenty-five (83%) patients remain progression-free, median 27 months from protocol entry. Conclusions: Seventy percent objective response rate for HG and avoidance of radiotherapy for 93% of LG was obtained using the I/C regimen. Remarkable fast clinical responses and functional recoveries occurred. No significant financial relationships to disclose.

Increasing Use of CBT Suggests Promising Future

Increasing Use of CBT Suggests Promising Future

Physiological and Psychological Factors May Be Involved in Remarkable Recovery

Although rare, spontaneous remissions or remarkable recoveries occur and are sometimes documented in the medical literature. In the past, researchers who examined remarkable recoveries were able to identify some components of cellular healing. Modern day examination could identify previously unknown interventions or keys to self-healing. Today's researchers suspect that physiological and psychological factors may be involved.

Cancer Recovery and the Spirit

The present study addresses the definition and exploration of the existential and spiritual experience of persons who had spontaneously remitted or made a remarkable recovery from cancer. Spontaneous remitters had experienced a remission without having allopathic treatment which could account for the cancer regression. Those with remarkable recoveries may have had treatment, but had been given a prognosis of less than a 20% chance of survival in a specific number of months or years, and had survived at least five years past this time. The narratives of the ten participants indicated that cancer proved to be a wake-up call propelling them into unprecedented existential and spiritual growth. Nine of the participants reported that they had healed not only at physical, but also at emotional and spiritual levels. Most described a new and intensely numinous relationship with the divine and with the unity of all beings which was not religiously oriented. Nine out of ten participants felt that cancer had been a gift.

Dr. Ross and Ms. Ellason Reply

Back to table of contents Previous article Next article Letter to the EditorFull AccessDr. Ross and Ms. Ellason ReplyCOLIN A. ROSS, M.D., and JOAN W. ELLASON, M.A., L.P.C., COLIN A. ROSSSearch for more papers by this author, M.D., and JOAN W. ELLASONSearch for more papers by this author, M.A., L.P.C., Dallas, Tex.Published Online:1 Sep 1998https://doi.org/10.1176/ajp.155.9.1304aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We agree with most of the methodological limitations pointed out by Drs. Powell and Howell. Our study lacked controls and a standardized treatment protocol, and subjects were recruited at their most symptomatic. Some of the improvement was probably due to spontaneous remission. The efficacy of psychotherapy for dissociative identity disorder is not a scientific fact.We disagree that a tautology occurred because of our use of outcome measures to assign subjects to integrated versus nonintegrated groups. Only the DSM-IV criteria for dissociative identity disorder from the Dissociative Disorders Interview Schedule were used in this assignment. No other outcome measures influenced this assignment.On the basis of our data, it seems unlikely that properly conducted therapy for dissociative identity disorder causes deterioration or chronic illness. Many people who receive this diagnosis make remarkable recoveries, given their degree of baseline comorbidity. Our data support allocation of resources to more rigorous prospective treatment outcome studies. In light of the methodological limitations of our study, one can no more attribute therapeutic causality to medications than to psychotherapy or spontaneous remission. There are many ethical, logistical, and methodological problems in designing and conducting rigorous treatment outcome studies for dissociative identity disorder. Treatment to stable integration often takes 4 or 5 years. It would be unethical to randomly assign subjects to a placebo group for that long. Therapists who believe in the specificity of psychotherapy for dissociative identity disorder would be unlikely, as a matter of personal conscience, to participate in a study that involved random assignment to 5 years of placebo treatment. Therefore, one could not recruit therapists to the study. The likelihood that patients would stay in the study in the placebo control condition for that long without dropping out is minimal.Prospective random assignment to placebo or waiting-list control groups in a treatment study for dissociative identity disorder is impractical. We suggest that different schools of thought should be compared to each other. At present, our school of thought is the only one that has provided prospective treatment outcome data with scientific methodology of any kind. The burden is now on competing schools of thought to match or exceed this level of methodology and to demonstrate a superior outcome.We plan to initiate a prospective treatment outcome study beginning at the time of initial diagnosis. It will include measures of health care utilization, employment status, clinical variables, and treatment modalities employed.Another approach would be to screen a large population base, such as all individuals covered by a major managed care company. Subjects with undiagnosed dissociative identity disorder could be identified with the test battery used in our study. Half could be randomly assigned to the treatment we recommend, and half could be left undiagnosed and tracked as they receive conventional treatment for other comorbid disorders.We hope that such studies are completed over the next decade and subjected to rational, reasonable methodological scrutiny such as that provided by Drs. Powell and Howell. FiguresReferencesCited byDetailsCited By Volume 155Issue 9 September 1998Pages 1304a-1305 Metrics History Published online 1 September 1998 Published in print 1 September 1998

Lack of theoretical basis for predicting rate and pathways of recovery

An inadequate basis for precisely predicting the outcome of lotic ecosystem recovery, whether due to unaided natural processes or management techniques or both, exists because: (1) the field of ecology has not yet matured as a rigorous predictive science; (2) the precise sequence of events, including climatic occurrences, affecting the recovery process may be unique events and thus rarely or never repeated; and (3) even when attempts are made to control the recolonization process through introduction of species, etc., the interaction of these species may not follow deterministic models. Although this symposium focuses on lotic ecosystems, such systems are influenced strongly by exports from the surrounding land mass and, under certain circumstances, this may be the overriding influence on the recovery process; therefore, unless the boundary conditions are determined realistically, the recovery process may not follow desirable pathways. Despite the lack of a robust theoretical support base for lotic ecosystem recovery, some remarkable and rapid recoveries have occurred to either a close approximation of the original condition or to a condition ecologically superior to the damaged condition. In some cases, the recovery was due entirely to natural processes and, in others, often followed relatively straightforward management practices. There is evidence indicating that lotic ecosystem restoration is both cost effective and likely to produce satisfying results relatively rapidly. It is both fortunate that this is the case, since society is likely to support such efforts when the results have been extraordinarily successful, and unfortunate since restoration ecology needs a predictive capability.

North American blastomycosis in Africans

Two young adults, one a native of Libya and one a Sudanese from Saudi Arabia, were referred at different times to the chest service at Westminster Hospital in London with a diagnosis of tuberculosis. They both had neurological deficits due to vertebral lesions. In spite of the fact that neither patient had ever been to North America, diagnoses of North American blastomycosis were established; both patients made remarkable recoveries on amphotericin B therapy.

A Synthesis of Knowns, Unknowns, and Policy Recommendations from the Sea Lamprey International Symposium

The Sea Lamprey International Symposium (SLIS) has provided a broad spectrum of facts and speculations for consideration in future research and management programs. Many aspects of the laboratory biology and field life history of the sea lamprey (Petromyzon marinus) are now well understood. There is little question that it can now be controlled by chemical larvicides, and perhaps in the future by more efficient integrated control programs. There is correlative evidence (wounds, scars, catch curves) that lamprey caused major mortalities in some fish species, and that control in conjunction with stocking has lead to remarkable recoveries of salmonid stocks in the Great Lakes. However, there are great gaps in understanding about just what the lamprey does under field conditions, and it is not yet possible to reject several hypotheses that assign lamprey a minimum or transient role in fish stock changes. Further studies on details of lamprey biology are, in themselves, unlikely to fill the gaps; one alternative is to conduct a large-scale field experiment involving cessation of lamprey control while holding other factors (fishing, stocking) as steady as possible. If it is decided to proceed with management on the assumption that lamprey are important, without the major field experiments to confirm it, then at least the following steps should be taken: (1) the chemical treatment program should be reviewed in detail, with a view to finding treatment schedules that will minimize frequency and dose rates for lampricide applications; (2) pilot studies on alternative control schemes (sterile male, attractants, barriers) should only be funded if they are statistically well designed (several replicate and control streams), and involve quantitative monitoring of lamprey spawning success and subsequent total production of transforming larvae; (3) the lake trout (Salvelinus namaycush) stocking program should be maintained at its present level, and should involve diverse genotypes rather than a few hatchery strains; (4) growth in the sport fisheries for lake trout should be curtailed, and commercial fisheries should not yet be permitted; (5) a multispecies harvesting policy should be designed that takes into account the buffering effect of each species on lamprey mortality suffered by others (i.e. should some species not be harvested at all, and viewed instead as buffers for more valuable species?); and (6) a program should be developed for restoring, by culture if necessary, native forage species in case the introduced smelt and alewife should collapse under pressure from fishing and prédation by the growing salmonid community.Key words: sea lamprey, proposed research, fishery management, mathematical models, population dynamics

Reserpine and Chronic Psychosis: Two-Year Outcome in a Treatment Group

In the last few years a number of new pharmacological agents have been introduced into psychiatry and reserpine has been one of the most controversial of these. Reports have varied from the over-enthusiastic (Noce, Williams and Rapaport, 1954), to the cautiously optimistic (Moore, 1956) and even the frankly sceptical (Cutler, Monroe and Anderson, 1957). It would be true to say, however, that all mental hospitals use reserpine now to some extent and nearly all psychiatrists are agreed that some remarkable recoveries have occurred. However, many questions remain to be answered—What kind of case improves?—What is the nature of the improvement qualitatively?—How lasting is the effect? Time alone gives the answer to some of these questions which are constantly recurring phenomena in therapeutics.

Remarkable Recoveries Cited for Kenny Polio Treatment

Remarkable Recoveries Cited for Kenny Polio Treatment

OTITIC MENINGITIS SUCCESSFULLY TREATED WITH SULFANILAMIDE

In recent years the literature has recorded and many physicians have observed remarkable recoveries from intensive infection with Streptococcus haemolyticus. A great deal of credit for these cures has been attributed to sulfanilamide, and justly so. In this report, a case of positive meningitis caused by Str. haemolyticus superimposed on acute mastoiditis due to Str. haemolyticus, both originating from acute otitis media, in which treatment was successful is detailed. That sulfanilamide played an important role in this cure will be borne out by the following facts. REPORT OF A CASE On Jan. 19, 1938, the patient, R. A., aged 7 years, was admitted to the ear, nose and throat service of Dr. Francis W. White, at the French Hospital. The history revealed that one week prior to admission there had been spontaneous rupture of the right ear drum. Drainage continued without any alarming symptoms until the day of admission to