Psychoanalytically oriented hypnotic treatment of autoerythrocytic sensitization and blindness.
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Any eye injruy due to blunt trauma calls for a measurement of visual acuity as part of the initial examination. Blunt trauma may result in a black eye or in a far more serious injury such as blowout fracture, hyphema, or macular edema.
It is necessary to determine whether easy bruising in children is caused by a hemorrhagic disorder. A careful history for the patient and family should be obtained and a physical examination should be done. Any positive indications of hemorrhagic diathesis call for basic coagulation screening tests.
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Spontaneous, widespread bruising in apparently healthy individuals relatively common among Thai children. It is a transient problem, unaccompanied by any common bleeding disorder of childhood. The physical defect is limited to the painless cutaneous lesions. Screening tests for hemostasis as well as tests of platelet function were measured in 24 of these patients. The significant abnormal findings were eosinophilia, prolonged bleeding time, positive tourniquet test and platelet dysfunction--i.e., defective ADP release and adhesivity to glass beads. So far, the condition appears to 0e a self-limited diathesis of unknown etiology.
A case is presented of a diabetic, hypertensive, female patient who suffers from a bleeding complication from application of an ambulatory blood pressure monitor. A recent literature search is referred to and practitioners are cautioned against this adverse reaction.
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Using currently available equipment for panoramic hysteroscopy, the size of images viewed cannot be accurately judged because of the magnifying and distorting effects of the objective lens. This study has demonstrated that magnification by the hysteroscope lens can alter the apparent size of images by up to 27%. An additional effect of lens distortion can alter the apparent size of images viewed by up to 28%, depending on the position of the image in the field of view. These effects are independent and may be additive. Thus, the apparent size of intrauterine structures at hysteroscopy may bear little resemblance to their actual size. Image-correction methods are described which reduce the effects of image magnification on the apparent size of an object viewed through the hysteroscope to 7%, and the effect of distortion to 3 %. This technique can greatly improve the accuracy of measurement at hysteroscopy, and has been utilized in this study for the precise measurement of superficial endometrial vascular diameter (mean+/-SEM) in 34 Norplant users (120+/-11.6 microm) and 20 women with spontaneous menorrhagia (74+/-7.2 microm). It has also confirmed the presence of scattered dilated vessels (up to 777 microm in diameter) on the endometrial surface in some Norplant users.
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We reviewed clinical presentation, investigations, therapy, prognosis and outcome of 232 patients with primary (AL) cardiac amyloidosis. There were 142 men and 90 women. Median age at presentation was 59 years (range 29-85). AL heart disease was unusual both in patients under the age of 40 (3.0%) and in non-Caucasians (6.5%). Fatigue and weakness were the commonest presenting symptoms. Hallmark features of periorbital ecchymoses and macroglossia were present in 12.5% and 27.2%, respectively. AL cardiac amyloidosis was unusual in isolation (3.9%), and most frequently patients had features of multiorgan dysfunction; heavy proteinuria and features of malabsorption predominating in this respect. Heart involvement represents the worst prognostic indicator, with a median survival from diagnosis of 1.08 years, falling to 0.75 years with the onset of heart failure. Current therapeutic procedures appear to prolong survival, with left ventricular wall thickness, mass and ejection fraction on echocardiography and late potentials on signal averaged electrocardiography of use in prognostic stratification. Cardiac involvement from AL amyloidosis is rapidly fatal. It should be suspected in all patients with heart failure who have wall thickening on echo, normal chamber sizes, low EKG voltages and evidence suggesting a multisystem disease.
A rapid clinical and epidemiological method of grading Capillary Resistance (CR) based on the appearance of petechiae following negative pressure on the skin of the forearm is described, and the results of testing 469 postmen aged 22 to 63 years are given. CR is shown to be increased in men who have had back pain within 24 hours of testing and no difference was found between men who had had back pain in the past and those who denied ever having had back pain. A separate series of 35 post-laminectomy patients examined at least 10 months after operation and who were shown to have disc disease at operation and/or on myelogram were found to have low CR. This work suggests that the changes involved in disc disease are not limited solely to the discs, but may involve collagen/elastic tissue or ground substance elsewhere as for example in this case when detectable in a test on the forearm. Secondly, it is suggested that CR grading could be a helpful discriminating test for 'disc disease' among those presenting with back pain of undetermined diagnosis.
Although senile ecchymoses are a well-recognized phenomenon on hospital wards, in patients who die in other settings they may be wrongly interpreted as bruising caused by physical assault. Therefore, we studied a total of 410 elderly (> 50 years of age) patients by a prospective examination of autopsy reports to elucidate their nature, including their general frequency, their anatomical distribution, and their physical appearance. We found a clear association with increasing age and a common distribution on the arms, rather than the neck or legs. One unique finding is that ecchymoses are related to place of residence, in that less mobile elderly persons are more likely to develop this condition, possibly as a result of lifting.
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Splenectomy in the treatment of thrombocytopenic purpura associated with lupus erythematosus has afforded satisfactory overall results in a group of ten patients. Postoperative deaths occurred in two patients, each of whom had significant underlying problems. Clinical manifestations of SLE-induced thrombocytopenic purpura included ecchymoses, petechiae, menorrhagia, epistaxis, and hematuria. Splenectomy in this disorder should be reserved for cases in whom corticosteroids do not produce satisfactory results, or in whom unacceptably high doses are required. Follow-up indicates long term control of thrombocytopenic purpura following splenectomy.