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PubMed2005

[Epidural haematoma in a newborn].

Birth injuries occur occasionally but, in contrast, perinatally acquired epidural and intracerebral hematomas as well as neonatal skull fractures are extremely rare. The appropriate diagnostic and therapeutic modalities depend on the size and site of the injury as well as any accompanying diseases. We report the case of a neonatal epidural and intracerebral haematoma with skull fracture following secondary caesarean section. There was no evidence for trauma during pregnancy, birth injury or other possible causes of bleeding. The haematoma was decompressed surgically. One year after surgery the boy suffers from moderate neurological compromise and focal seizures.

Apgar Score↗
PubMed1987

The stress analogy.

The author calls attention to the advantages of using the engineering meaning of stress and strain when applying these terms to describe the effects of social and physical forces on people. Such an analogy opens up the possibility of measuring the amount of damage from excess stresses existing in people, as well as estimating their limits and remaining strengths. It also explains why some people are more affected by a given stressor than other people.

General Adaptation Syndrome↗
PubMed1977

Four cases of mania associated with bereavement.

The difficulties of research connecting events in the social field with onset of an illness are illustrated by four case studies exemplifying differing aspects of pathological grief, where the stress of an unresolved bereavement crisis was associated with the onset of a manic illness. The studies are: a) in early bereavement; b) as a repeated anniversary reaction; c) after 10 years, as a result of pathological identification and reparation; d) the loss of a symbiotic relationship. These were associated with widely varying temporal relationships between the loss, the stress, and the illness (8 days, five anniversaries over 6 years, 10 years, and 2 1/2 years, respectively). It is postulated that mania supervenes at a time when stress ("distress") is persistent, and the pathological mourning unresolved and unadaptive. The sequence-pathological grief, distress, mania--is viewed in a psychosomatic model and this view supported. The notion of "switch into mania" is also supported, and the importance of diverse theories to the increased understanding of the natural history and prevention of psychiatric illness is underlined.

Adult↗
PubMedDate not supplied

Short- and long-term association between uric acid and a natural disaster.

OBJECTIVE: This paper analyzes the longitudinal relationship between serum uric acid level and a natural disaster. METHODS: The sample consists of factory workers who were participating in a longitudinal epidemiological study of coronary heart disease risk factors. Participants were seen in 1975 (baseline), 1980 (5 year follow-up), and 1987 (12 year follow-up). The 5 year (1980) follow-up examination was interrupted by a major earthquake and resumed 2 weeks after the quake. At this examination, participants seen after the quake had, on the average, significantly lower serum uric acid than those seen before the earthquake. In 1987 (7 years after the quake), participants were questioned whether or not (in their own perception) they were still suffering from damages due to the 1980 earthquake. RESULTS: At the examination in 1987, participants who reported suffering from damage due to the 1980 quake showed on the average significantly increased serum uric acid compared with participants who reported not suffering from damages due to the 1980 quake. The analyses of the data of 578 individuals who participated in all three examinations confirmed these findings and showed that they were independent from levels of uric acid measured prior to the disaster. CONCLUSIONS: The reason for this apparent different association with uric acid and acute and long-term exposure to the quake remains to be clarified but these findings are consistent with the existence of diverse patterns of physiologic response to different stressors.

Adaptation, Psychological↗
PubMedDate not supplied

Shaking up immunity: psychological and immunologic changes after a natural disaster.

OBJECTIVE: The 1994 Northridge earthquake created life disruption and psychological distress for employees of the nearby Sepulveda VA Medical Center. We were interested in the immunologic correlates of disruption and distress under these stressful circumstances. METHOD: Sixty-eight employees were examined beginning 11 days post-earthquake and were observed until about 4 months after the earthquake, during which time three psychological and immunologic assessments were done. Subjects experienced life disruption from the earthquake itself, damage to home and possessions, injury to self and others, and damage to and functional disruption of workplace. Questionnaires assessed degree of life disruption (personal and work-related), mood, earthquake-specific distress, and repression (alexithymia, coping style or "Type C", and "immunosuppression-prone" traits). Immune measures included lymphocyte subsets-total T (CD3+), helper T (CD4+), cytotoxic T (CD3 + CD8+), B (CD19+), and natural killer (NK; CD3 - CD16 + CD56+)-as well as lymphoid cell mitogenesis (PHA and PWM), and NK cell cytotoxicity. RESULTS: Along with a lessening degree of distress over time, a number of immunologic measures declined over the assessment period (CD3+, CD8+, CD16 + 56+ cells. T cell blastogenesis, and NK cell cytotoxicity). Furthermore, subjects reporting low distress had higher numbers of CD3+ and CD8+ cells and a higher proliferative response to PHA. Those with distress corresponding to life disruption had highest levels of CD3+ and CD8+ cells. Measures of repression did not relate directly to immunity. CONCLUSION: These results suggest that appropriateness of psychological reaction to the realistic degree of life stress was least disruptive of an aspect of immunity.

Adaptation, Psychological↗
PubMedDate not supplied

Posttraumatic stress symptoms, intrusive thoughts, loss, and immune function after Hurricane Andrew.

OBJECTIVE: To examine the impact of and relationship between exposure to Hurricane Andrew, a severe stressor, posttraumatic stress symptoms and immune measures. METHODS: Blood draws and questionnaires were taken from community volunteer subjects living in the damaged neighborhoods between 1 and 4 months after the Hurricane. RESULTS: The sample exhibited high levels of posttraumatic stress symptoms by questionnaire (33% overall; 76% with at least one symptom cluster), and 44% scored in the high impact range on the Impact of Events (IES) scale. A substantial proportion of variance in posttraumatic stress symptoms could be accounted for by four hurricane experience variables (damage, loss, life threat, and injury), with perceived loss being the highest correlate. Of the five immune measures studied Natural Killer Cell Cytotoxicity (NKCC) was the only measure that was meaningfully related (negatively) to both damage and psychological variables (loss, intrusive thoughts, and posttraumatic stress disorder (PTSD). White blood cell counts (WBCs) were significantly positively related with the degree of loss and PTSD experienced. Both NKCC (lower) and WBC were significantly related to retrospective self-reported increase of somatic symptoms after the hurricane. Overall, the community sample was significantly lower in NKCC, CD4 and CD8 number, and higher in NK cell number compared to laboratory controls. Finally, evidence was found for new onset of sleep problems as a mediator of the posttraumatic symptom-NKCC relationship. CONCLUSIONS: Several immune measures differed from controls after Hurricane Andrew. Negative (intrusive) thoughts and PTSD were related to lower NKCC. Loss was a key correlate of both posttraumatic symptoms and immune (NKCC, WBC) measures.

Adolescent↗
PubMed1984

Stress and coping: constructs for nursing.

'Stress' is considered to be an important construct for consideration by nurses, as it helps in the understanding of the patients' responses to illness. In this paper there is an exploration of conditions under which stress may occur. 'Coping' is also discussed. Coping potentially reduces stress either by dealing with demands and stressors, or with their effects on the individual.

Adaptation, Psychological↗
PubMed1984

The modifying effect of spinal anaesthesia on intra- and postoperative adrenocortical and hyperglycaemic response to surgery.

Plasma cortisol and glucose were measured in 24 patients undergoing abdominal hysterectomy during spinal anaesthesia with 0.5% hyperbaric tetracaine or neurolept anaesthesia. The sensory level of analgesia to pinprick extended to at least T4 before skin incision in the spinal group. The mean sensory analgesic level regressed almost linearly, reaching the fourth lumbar segment 4 h after incision. Plasma cortisol and glucose measurements from before to 9 h after skin incision showed significant increases in both parameters during and after surgery. Plasma cortisol and glucose levels were significantly lower during and immediately after surgery in the spinal group, but later postoperatively the mean levels were similar in the two groups. The increase in plasma cortisol 1 h after skin incision in the spinal group correlated to the segmental level of analgesia at that time (r = 0.77, P less than 0.01) and a similar correlation was found with regard to plasma glucose changes (r = 0.60, P less than 0.05). The regression lines showed that maintenance of a sensory analgesic level about the fourth thoracic segment prevented the adrenocortical and hyperglycaemic response to surgery. These findings are in accordance with the anatomical assumption that the upper segmental level of visceral afferent input to the spinal cord is about the fourth thoracic segment. Our results further demonstrate that the inhibitory effect of spinal anaesthesia on the stress response to surgery is transient, and correlates to the regression of sensory analgesia.

Adult↗