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Biomedical subjects

A H Chapman

Publications and source records attributed to A H Chapman.

At least 37 records · Page 2Linked to original sources
PubMed1997

The changing face of emphysematous cholecystitis.

Emphysematous cholecystitis is a variant of acute cholecystitis characterized by the presence of gas in the gall bladder lumen, wall or pericholecystic tissues in the absence of an abnormal communication between the biliary system and the gastrointestinal tract. In the past, the diagnosis has relied on the plain abdominal radiograph (AXR), since there are no clinical features to separate this condition from simple acute cholecystitis. The apparently high mortality and morbidity associated with emphysematous cholecystitis has previously emphasized the importance of emergency cholecystectomy. We have reviewed eight cases of emphysematous cholecystitis presenting to this hospital over the last 5 years. The diagnosis was made on AXR in only one of these cases. Ultrasound (US) scans were performed in all eight cases, of which five were positive and three negative, due to non-visualization of the gall bladder. In the three negative cases, the diagnosis was made on subsequent CT scans. On initial clinical examination, only one of the eight patients appeared systemically unwell and conservative management was employed in five of the patients. The remaining three patients underwent cholecystectomy within 3-5 days because of continuing signs or symptoms. It is concluded that the AXR is relatively insensitive in the diagnosis of emphysematous cholecystitis. As a result of the regular use of US in suspected hepatobiliary disease, emphysematous cholecystitis is being diagnosed with increased frequency, uncovering a broad spectrum of disease ranging from mild to severe. Previously, failure to separate milder cases from simple acute cholecystitis may have been responsible for reports of unremitting severity and progression requiring emergency cholecystectomy. Based on clinical assessment, conservative surgical management is possible in a significant proportion of patients.

Acute Disease↗
PubMed1997

The concept of nemesis in psychoneurosis.

A patient who has a nemesis fear as the basic process in his psychoneurosis feels that he is destined to repeat the life course of one of his parents to eventual long-term psychosis, or incapacitating physical illness or death by illness or accident. He feels that this will occur at about the same age as that at which his parent suffered his misfortune. The patient during his childhood and adolescence had a traumatic relationship with this parent, and is haunted by guilt feelings about it, and fears that avenging destiny, or nemesis, requires that he pay with a similar misfortune for that which he feels he caused. These patients improve much in psychotherapy, but the underlying nemesis fear, though much reduced in severity, is not entirely eliminated.

Adult↗
PubMed1996

PEG -- is the E necessary? A comparison of percutaneous and endoscopic gastrostomy.

We describe our experience of 45 percutaneous gastrostomies using 12 F Wills-0glesby (Cook, Inc, Bloomington, IN, USA) catheters and 33 percutaneous endoscopic gastrostomies using 12 F Bower PEG's (Corpak, Inc, Wheeling, IL, USA). Tube displacement was a continued problem with the Wills-Oglesby catheter resulting in three patients developing peritonitis with one death. In view of this we would recommend as the preferred technique the endoscopic placement of Bower PEG catheters unless there are contraindications to the endoscopic technique.

Catheterization↗
PubMed1996

Selected issues in quality improvement and risk management.

OBJECTIVE: To provide an overview of selected issues in quality improvement and risk management. DATA SOURCES: Published articles, books, and standards pertaining to quality improvement and risk management. CONCLUSION: The changing health care environment has intensified the need for monitoring processes of home care, patient outcomes, and risk management issues. Quality improvement and risk management programs can provide guidelines for the home health staff to impact outcomes of patient care and patient and caregiver satisfaction. IMPLICATIONS FOR NURSING PRACTICE: Home health care nurses are involved in the evaluation of systems, processes, and outcomes. Their involvement in identifying problems, providing creative solutions, and successfully implementing systems and processes is essential for quality improvement. They also must be knowledgeable of risk management and be involved in the identification and resolution of potential risks to themselves and their patients.

Home Care Services↗
PubMed1996

Obsessions of infanticide and imminent psychosis.

In young mothers an obsession of infanticide, that is, fear that they may murder their children, may be coupled with an obsession of imminent psychosis, that is, fear that the first obsession is a sign of approaching insanity. Sixteen mothers with this clinical picture were evaluated in interviews. Seven of them entered psychotherapy and improved. The causative factors in childhood and adolescence wich led to the later development of these obsessive difficulties are analyzed. Even when psychotherapy was not possible, as was the case in nine patients, they should be strongly reassured and explanations should be given about the nature of the problem, for such encouragement and clarification helps them to improve to a significant extent. The prognosis of patients who have systematic psychoterapy is good.

Adult↗
PubMed1995

A barium enema training programme for radiographers: a pilot study.

We describe a training programme designed to instruct radiographers how to perform the double contrast barium enema (DCBE). The programme was assessed by comparing the first 50 unsupervised examinations with studies performed by senior registrars in radiology. Comparison was made by marking each study blind in terms of barium coating, colonic distension and visualisation of the colon in double contrast. A note was also made of the number of exposures, screening time, examination time and complications. No difference was found in any of these parameters when comparing the two groups. A further 50 patients were assessed at one year and this showed that standards had been maintained in terms of the above criteria. Follow-up at 3 years in the initial group has shown no missed pathology. We believe that delegation of the performance of the DCBE to radiographers is both acceptable to the patient and safe.

Barium Sulfate↗
PubMed1995

The influence of Nietzsche on Freud's ideas.

BACKGROUND: The striking analogies between the ideas of Freud and Friedrich Nietzsche, whose works were published from one to three decades before those of Freud, have been commented upon, but no previous systematic correlation of the ideas of Nietzsche and Freud has been made. METHOD: The major works of Nietzsche were read, and each possible analogy to an idea later broached by Freud was correlated by a systematic review of his works. Any references to Nietzsche in Freud's writings and reported conversation were culled. RESULTS: Concepts of Nietzsche which are similar to those of Freud include (a) the concept of the unconscious mind; (b) the idea that repression pushes unacceptable feelings and thoughts into the unconscious and thus makes the individual emotionally more comfortable and effective; (c) the conception that repressed emotions and instinctual drives later are expressed in disguised ways (for example, hostile feelings and ideas may be expressed as altruistic sentiments and acts); (d) the concept of dreams as complex, symbolic "illusions of illusions" and dreaming itself as a cathartic process which has healthy properties; and (e) the suggestion that the projection of hostile, unconscious feelings onto others, who are then perceived as persecutors of the individual, is the basis of paranoid thinking. Some of Freud's basic terms are identical to those used by Nietzsche. CONCLUSION: Freud repeatedly stated that he had never read Nietzsche. Evidence contradicting this are his references to Nietzsche and his quotations and paraphrases of him, in causal conversation and his now published personal correspondence, as well as in his early and later writings.

Austria↗
PubMed1995

The use of humor in psychotherapy.

Humor can be a useful treatment technique in the hands of some psychotherapists. It may help the patient to see painful life events and situations from less threatening perspectives, and can take the anxiety and guilt out of many difficult circumstances and incidents. Humor can be valuable in talking with parents about the problems of their adolescent children, in working with adolescents themselves, in discussing difficulties encountered in the workplace and in social environments, in decreasing obstructive awe of the therapist and apprehensiveness about treatment, in dealing with problems such as male sexual impotence, and in many other areas. Some therapists, however, handle humor awkwardly; in their hands it misfires or falls flat, and they should avoid it.

Humans↗
PubMed1994

Tentative interpretations in psychotherapy.

The nature and technique of the tentative interpretation are described. Its usefulness and advantages are outlined, and its field of application in psychotherapy is discussed.

Humans↗
PubMed1993

Creutzfeldt-Jakob disease. A case report, with special attention to the electroencephalogram in this disorder and to its possible relationships to kuru, scrapie and "mad cow disease".

A case of Creutzfeldt-Jakob disease in a 58-year-old Brazilian cattle rancher and businessman is presented. The EEG was normal, which is consistent with the fact that it was made during the first half of his illness; in a later stage suppression of normal rhythms by slow moderate voltage waves would be expected. The resemblances of kuru, scrapie and "mad cow disease" to C-J disease are discussed. In each of these 4 illnesses the patient or affected animal (scrapie and "mad cow disease") (a) has a widespread spongiform encephalopathy and consequent dementia, myoclonic epilepsy and cerebellar and corticospinal symptoms. (b) Each illness is caused by a virus (or virus-like organism called a PrP or prion) which is unusually resistant to heat and entirely resistant to ultraviolet light and x-rays. (c) This causative agent can be transmitted to other mammals by intracerebral injection or, in the proved cases of 3 of them, by the oral route. Unresolved questions about C-J disease include the following: Are C-J disease, kuru, scrapie and "mad cow disease" essentially similar illnesses caused by the same virus or by subtle variants of it? What is the incubation period of C-J disease, and does its virus exist for long periods of time in some asymptomatic persons, some of whom may never become neurologically ill? How does this virus enter the bodies of most persons with C-J disease, and why does the clinical disease characteristically occur only in middle age?

Animals↗
PubMed1992

Radiology of excessive mucus production as a complication of congenital bile duct abnormalities.

Biliary obstruction was caused by viscid mucus in two patients with congenital bile duct abnormalities. In one patient this produced a progressive dilatation and obstruction of the common bile duct which eventually led to the patient's death; in the other there was a progressive segmental dilatation of the biliary tree which was surgically resected. We wish to emphasize that bile duct mucus has a characteristic appearance on cholangiography but is difficult to recognize on ultrasound and CT scans.

Adult↗
PubMed1992

The acute contrast enema in suspected large bowel obstruction: value and technique.

In order to determine the value of the acute contrast enema (ACE) as compared to the plain abdominal film for the diagnosis of colonic obstruction and to determine the optimal technique for performing this examination, we reviewed 140 cases performed over a 4 year period. The study shows that when provided with the case history and the plain abdominal films of patients referred for an ACE the diagnosis of colonic obstruction can be made with a sensitivity of 84% and a specificity of 72%, whereas the ACE has a sensitivity of 96% and a specificity of 98%. The ACE resulted in two false negatives, one false positive and one technical failure, analysis of which has enabled an optimal technique for the performance of this examination to be recommended.

Colon↗
PubMed1992

Sonographically guided coeliac plexus block.

A sonographically guided anterior approach to block the coeliac plexus with local anaesthetic was attempted on supine patients before hepatobiliary interventional procedures. A satisfactory block was achieved in 8/9 patients and the minor complication of transient hypotension was encountered in two which were managed conservatively. Comparison with controls showed the coeliac block patients to require significantly less intravenous sedation and analgesia to control pain during these procedures.

Abdomen↗
PubMed1990

Percutaneous-endoscopic placement of endoprostheses for relief of jaundice caused by inoperable bile duct strictures.

Fifty-three patients with biliary obstruction caused by unresectable malignancy were treated by attempted insertion of an endoprosthesis by the percutaneous-endoscopic route. This was successful in 50 patients. A single endoprosthesis was inserted in each case. Both right and left hepatic duct decompression were obtained in 31 patients, but only unilateral or segmental drainage was achieved in 19 patients. Procedure-related complications occurred in 18 (36%) patients, and 15 (30%) patients died within 30 days of the procedure. Satisfactory resolution of jaundice was obtained in 26 (84%) patients with bilateral decompression and in 12 (63%) of those with unilateral drainage. The 30-day mortality rate was 26% for patients with bilateral and 37% for those with unilateral drainage. The morbidity rate from cholangitis after endoprosthesis insertion was 10% after bilateral and 32% after unilateral drainage. None of these differences was statistically significant. Surviving patients with satisfactory bile drainage were relieved of symptoms such as pruritus. The combined percutaneous-endoscopic technique enables difficult biliary strictures to be intubated. Although bilateral duct drainage is preferable, the palliation is often worthwhile even when segmental ducts alone are drained.

Adenoma, Bile Duct↗
PubMed1989

Palliation of obstructive jaundice with a biliary endoprosthesis. Comparison of insertion by the percutaneous-transhepatic and the combined percutaneous-endoscopic routes.

Thirty-eight patients with obstructive jaundice due to inoperable malignancy were referred for insertion of an endoprosthesis. In 19 this was performed by the percutaneous-transhepatic route, and in 19 by a combined percutaneous-endoscopic approach. Satisfactory bile drainage was achieved in 15 patients after combined percutaneous-endoscopic insertion and in 11 after percutaneous-transhepatic prosthesis insertion. Cholangitis occurred after the combined approach in five patients and after percutaneous-transhepatic insertion in nine. None of these differences were significant. Thirty-day mortality rates and mean survival times were similar for each approach (26% and 10 weeks after combined insertion, 21% and 9 weeks after percutaneous-transhepatic). Prostheses inserted by the combined route were easily replaced when they occluded. This was not possible after percutaneous insertion. The combined percutaneous-endoscopic approach appeared to be better tolerated by the patients and is suggested as the method of choice in strictures which can not be intubated by the endoscopic route alone.

Adult↗
PubMed1988

The value of a barium enema in the investigation of patients with rectal carcinoma.

A review of 545 patients with clinically diagnosed rectal carcinoma was conducted to determine the diagnostic usefulness of pre-operative barium enema and the frequency with which it was employed. Only 118 patients underwent pre-operative barium enema (21.7%). This successfully outlined the whole colon in 107 (90%). Synchronous carcinomas were detected in 9.3% of patients who underwent complete barium enema, compared to 4.3% of those who underwent laparotomy alone (P less than 0.05). Polyps were found in 23.4% of patients who had a barium enema but in only 14.7% of those who did not (P less than 0.05). Twenty-nine per cent of synchronous carcinomas and 11% of polyps were proximal to the descending colon and would have been beyond the reach of a flexible sigmoidoscope. Barium enema remains a useful investigation in patients with rectal carcinoma. It will outline the whole colon in most cases and will result in the detection of more synchronous carcinomas and polyps than if the surgeon relies on operative palpation alone.

Barium Sulfate↗