Biomedical subjects
Publications and source records attributed to D Silver.
The intense therapeutic encirclement maneuvers possible in long-term inpatient therapy of the borderline patient frequently stimulate emotional flooding and intense negative therapeutic reactions. Such reactions have understandable precipitants: a mixture of therapeutic goals, treatment methods, and defensive structures of the patient best conceptualized within an object-relations model.
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Twenty-two patients developed significant thrombocytopenia (5,000 to 96,000/cu mm; mean, 29,000/cu mm) while receiving prophylactic or therapeutic heparin. Seventeen of them developed serious thrombohemorrhagic complications which accelerated the deaths of six and contributed to the late death of one. Cessation of heparin therapy led to an immediate remission of the thrombohemorrhagic complications and thrombocytopenia, with no patient who was not already moribund dying, once appropriate therapy had been instituted. Platelet-count monitoring is recommended for all patients receiving heparin for more than 6 days, with cessation of heparin therapy mandatory for the successful management of patients with this disorder. Evidence is presented for an immunologic etiology for this disorder.
Eight cases of peritoneal mesothelioma have been seen at the University of Missouri Medical Center and affiliated hospitals since 1940. The incidence for our patient population is 0.24 cases per 100,000 patients. The nonspecific symptoms, physical findings, x-rays, and laboratory results usually preclude an early establishment of the diagnosis. The diagnosis was eventually established at laparotomy in seven cases and at autopsy in one. Only the benign mesothelioma was resectable; that patient is doing well 10 months after operation. The survival interval of the patients with malignant peritoneal mesotheliomas averaged 3 months, with the two patients who received chemotherapy surviving 3 and 6 months, respectively.
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Disulfiram had more pronounced sedative effects on healthy normal subjects with low levels of plasma dopamine-beta-hydroxylase (DBH) than it did on subjects with higher levels. It is suggested that DBH levels might provide a means of predicting increased susceptibility to disulfiram side effects.
Borderline patients evoke unique countertransference responses among members of the treatment team: pejorative behavior, undue optimism, and pessimistic nihilism to these patients, along with difficulties in limit-setting, and fragmentation of the treatment team are common. Frequent meetings and open communication within the treatment team are recommended in order to minimize the splitting that is central to these countertransference constellations.
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An experimental technique has been devised to study the acute respiratory and hemodynamic results of autologous fat embolism in dogs. By using a commercially available autotransfusion device, fat can be aspirated and reinfused into the venous circulation. Acute rises in pulmonary artery pressure and calculated pulmonary dead space can be produced, and arterial oxygen saturation is impaired. These changes correlate well with the appearance of intravascular embolized fat. Apparent intravascular clot formation is demonstrated, the fat droplet acting as a stimulus or nidus for clot formation. These changes were avoided when the infusate was first passed through a micropore filter.
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After a visit to Hong Kong, a 27-year-old salesman developed penile ulceration which failed to respond to three weeks' penicillin therapy. He then presented to hospital with acute paraphimosis. A clinical diagnosis of chancroid was confirmed by isolation of Haemophilus ducreyi. The ulcers healed after sulphonamide and streptomycin therapy. Although chancroid is an uncommon venereal disease in Australia, its incidence is still high in many tropical countries. It should be considered as a possible cause of genital ulceration in patients who have travelled overseas.
Increased heparin tolerance and recurrent thromboembolism which included myocardial infarction (3 patients), pulmonary embolism (2 patients) and complete aorto-iliac occlusion (2 patients), heralded the development of thrombocytopenia between the eighth and twelfth day of heparin therapy in six women and two men. The thrombocytopenia persisted until heparin was discontinued. Bleeding (cerebral hemorrhage) was the initial complication in one patients and occurred in conjunction with thrombotic complications in four other patients. Agglutination absorption testing in one and complement fixation testing in five patients suggested the presence of heparin dependent antiplatelet antibodies. After platelet recovery, four of the eight patients responded to parenteral heparin rechallenge with rapid decreases in their platelet counts. The early recognition of the syndrome with cessation of heparin therapy is imperative for the successful management of afflicted patients.
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The results of a retrospective study of patients undergoing carotid endarterectomy for hemispheric and/or nonhemispheric symptoms of transient ischemic attacks are presented. During an approximately 3-year period of follow-up observation, recurrent cerebral ischemia following carotid endarterectomy was two to three times more frequent among patients with nonhemispheric transient ischemia than among those with hemispheric transient ischemia. Patients with symptoms of both hemispheric and nonhemispheric transient ischemia had the highest frequency of transient ischemic attacks and stroke during the follow-up period and also had the greatest surgical morbidity and mortality. The results of this study suggest that carotid endarterectomy has little or no therapeutic value in treating patients with vertebral-basilar ischemia.