Headaches in an angry diabetic patient.
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Biomedical subjects
Publications and source records attributed to N B Levy.
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The kidney was the first vital organ to be transplanted and the progenitor of knowledge of transplant immunology and psychology. With dialysis, it has heralded a new phase of medicine in which organs necessary for life can be replaced by transplanted ones or by artificial means. Many factors play a role in the decision to donate a kidney. Psychiatric complications of renal transplantation include those arising as a result of the use of immunosuppressants, anxiety, and sexual dysfunctions. Treatment should address the identifications of patients who are prone for psychological complications, the use of psychotropic medications, and the use of behavioral techniques for sexual dysfunction.
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The purpose of this editorial is to give the reader a picture of the earliest days in the delivery of chronic dialysis. It is viewed by a psychiatrist who was asked to help evaluate patients in one of the first hemodialysis centers, not only in the United States, but in the world.
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Five monoclonal antibodies (MoAbs)(L6, 170H.82, 155, BrE-3 and BR96), most of which have been previously shown to target breast cancer and not normal tissues by immunoscintigraphic imaging, were evaluated for their frequency and pattern and immunohistochemical staining in 67 to 116 metastatic lesions from patients with ductal carcinoma of the breast. Immunoperoxidase staining in 75% or more of the cells occurred in 56/116 (48%) for L6, 44/89 (49%) for Br, -96, 58/102 (57%) for 155, 62/99 (84%) for 170H.82, and 65.67 (97%) for BrE-3. With the first three MoAbs, an additional 6-10% of the tumors showed staining in 50-75% of tumor cells. These results illustrate that most patients with metastatic ductal carcinoma have cancer tissue in which a high percent of cells will react to several of these selected MoAbs that target different epitopes. The high expression of the MoAb targets throughout the tumor tissue makes these antibodies potential candidates to carry immunologically directed radioimmunotherapy and is an aid in selecting patients for treatment.
A twenty-four-year-old woman is presented with multiple previous hospitalizations for joint and muscle pains. Guarded in her description of symptoms, she reports that "lupus" has been diagnosed at several hospitals over the past few years, unable to recall the name of any other than on previous hospital. The medical work-up failed to show any abnormality except that compatible with previously diagnosed von Willebrand's disease. In the discussion of the case, the patient's desire to be taken care of is seen as a major dynamic, causing her to fabricate illness. The diagnoses of Munchausen Syndrome, malingering, conversion reaction and hypochondriasis are discussed and differentiated from each other, and the treatment of Munchausen Syndrome is discussed.
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