Managed mental health, Medicaid, and medical cost offset.
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Biomedical subjects
Publications and source records attributed to N A Cummings.
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The inefficient manner in which psychotherapy is delivered renders mental-health practitioners vulnerable to the new emphasis in health-cost containment. It is estimated that in 1995 most health-care delivery will be controlled by five or six giant health corporations. Fifty percent of the mental-health practitioners in independent practice today are unlikely to survive. Those who do survive will either have learned the new delivery system, or they will be employees of corporate health. As frightening as these predictions may seem, there is also a window of opportunity for psychotherapists to get their house in order and to meet the challenge.
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The arthritis of rheumatic fever in adults may mimic acute gonococcal arthritis. To further characterize this clinical picture the features of six patients presenting with the migratory polyarthritis of acute rheumatic fever have been analyzed. There were two men and four women, ranging in age from 18 to 43; in five the initial clinical impression was gonococcal arthritis. In all patients, however, the diagnosis of acute rheumatic fever was subsequently established. Characteristics of acute rheumatic fever not commonly described included tenosynovitis in all six and an erythematous rash in three. In three patients synovial fluid WBC exceeded 28,000/cu mm, with greater than 90% neutrophils. In five of the six, gonococcal arthritis was ruled out by appropriate studies and by failure to respond to antibiotics in all patients. The one patient with serum antigonococcal antibodies had gonococcal pharyngitis and acute rheumatic fever.
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A new technique to detect anti-salivary duct antibody (ASDA) has been developed by using autoradiographic, rather than immunofluorescent methods. The antibody activity detected by autoradiography is probably classic ASDA. Both techniques may be consecutively performed on the same tissue section without attenuation of either. Some of the potential advantages of the radiolabelling of ASDA are pointed out, and a few preliminary experiments using the labelled antibody as a marker are presented.
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A 46-year-old man with Behçet syndrome and a long history of recurrent bouts of colitis was studied by sigmoidoscopy, barium enema x-ray film, and colon biopsy. A nonspecific colitis characterized by shallow mucosal ulcerations and submucosal mononuclear infiltration in the absence of meaningful roentgenolographic changes was seen. A histopathological comparison was made between the oral and colonic lesions. The aphthous colitis appears, therefore, to be a colonic manifestation of Behçet syndrome, differing from typical chronic nonspecific ulcerative colitis in terms of clinical course, severity, and histologic appearance. The simultaneous occurrence of Behçet syndrome and inflammatory disease of the colon was discussed in terms of the differential diagnosis of colitis.
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