Biomedical subjects
Publications and source records attributed to A W Halliday.
We describe a patient originally diagnosed with clinically definite multiple sclerosis whose actual diagnosis of conversion disorder was revealed when his examination was found to be fictitious, his radiological, electrophysiological, and biochemical tests were determined to be normal, and his symptoms were reversed through the use of sodium pentothal and hypnosis.
The cases presented here were patients referred for neurologic disability evaluations. They met the three selection criteria presented and underwent the four-phase pentothal hypnosis procedure described and at the conclusion were diagnosed as having psychiatric morbidity. We recommend that the sodium pentothal hypnosis procedure be considered for use whenever there is concern for psychiatric co-morbidity in a patient with presumed physiologic disease.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A total of 58 popliteal aneurysms were found in 40 patients presenting between June 1982 and May 1989. Of these, 51 were caused by atherosclerosis, and there were five post-stenotic aneurysms associated with entrapment, one mycotic and one post-traumatic aneurysm. There were 18 patients with bilateral aneurysms, and two others had the first side repaired elsewhere before referral to this hospital. Aneurysms were found at other sites in 16 patients. Urgent treatment was needed for 32 patients (80%). Two required streptokinase treatment to clear arteries distally. Three needed fasciotomy for compartment syndrome. Two patients had above-knee amputation. Of 36 urgent operations, 13 had postoperative complications (36%). Four grafts were later revised successfully. At mean follow-up of 23 months (range 3-96 months), three patients had claudication secondary to preoperative distal arterial occlusion, and one patient had residual mild foot drop. These operative results contrast sharply with the low complication rate after elective operation for popliteal aneurysm. In these patients, 14 asymptomatic aneurysms were repaired uneventfully. Four patients who did not undergo elective operation later developed acute thrombosis (3) and rupture (1). This experience supports our policy that early elective treatment for popliteal artery aneurysm is the most appropriate choice.
Although it is well recognized that patients with cobalamin (vitamin B-12) deficiency can develop neuropsychiatric problems, primary care physicians do not frequently realize that patients presenting with only vague neurologic complaints can have vitamin B-12 deficiency as the etiology. During a 1-year period, six patients presented to the Neurology Clinic at Brooke Army Medical Center, Fort Sam Houston, Texas, after evaluation at the primary care level for their neurologic complaints. All six had cobalamin deficiency, and none were anemic. Military primary care physicians should be aware of the various neurologic presentations of these patients.
This report of a series of 25 patients with cervical paragangliomas reviews the experience of one surgeon over a period of 13 years. A total of 26 resections were performed with no mortality and no hemiplegia. Two patients required carotid reconstruction. Eight patients had a permanent cranial nerve palsy but in seven this was due to involvement of the nerve by the tumour. Lymph node involvement occurred in two patients. Only one patient has developed recurrent tumour. These tumours are locally malignant and resection offers a chance of cure.
Explore the source record for details and available documents.
Congenital arteriovenous malformations have long been recognized to be life-threatening abnormalities. Treatment is aimed at control rather than cure. Recent developments in diagnostic and therapeutic techniques have led to a better understanding of their pathophysiology and to new management strategies.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Preoperative nutritional assessment was performed for 32 patients undergoing surgery for malignant hepatobiliary and pancreatic disease. Weight, mid-arm circumference, total body potassium (TBK), and skin test reactivity were significantly reduced in the seven patients who died after operation (p less than .05, Student's t-test and Fisher's exact test). Analyses of major life-threatening complications indicated that those who had a complicated postoperative course (17 patients) had a significantly lower TBK (p less than .05, Fisher's exact test). Using linear discriminant analysis (SPSS computer program), correct prediction of postoperative death or survival was possible in 85% of patients if measured by TBK alone, and in 83% if weight loss and serum albumin were used. Seventy three percent were correctly classified as complicated or uncomplicated by TBK alone, but serum albumin and weight loss were not helpful in predicting patients with complications. This study shows that malnutrition and operative risk may be identified preoperatively in patients with malignant hepatobiliary and pancreatic disease. Objective improvement may be achieved by intensive nutritional support.