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At least 109 records · Page 6Linked to original sources
PubMed1978

Porphyria variegata--studies of an affected couple and their children.

Porphyria variegata affects approximately 1 in 200 Afrikaans-speaking people in South Africa. This paper reports the first case of a marriage between 2 people with porphyria variegata and describes investigations carried out on their 2 children, who do not exhibit any signs of the disease. The wife had suffered 1 miscarriage at 4 months' gestation.

Adult↗
PubMed1992

Tension pneumocephalus associated with rupture of a middle fossa encephalocele. Case report.

Acquired nontraumatic (spontaneous) encephaloceles of the middle fossa are not common. Rupture of an encephalocele frequently leads to a cerebrospinal fluid fistula. Tension pneumocephalus consequent to rupture of an encephalocele has not been previously reported, but conceivably occurs by means of a ball-valve mechanism in the ensuing fistulous tract. An unusual case is presented of an elderly man who suffered acute life-threatening neurological symptoms from a tension pneumocephalus that likely developed from rupture of an acquired nontraumatic encephalocele of the left middle fossa. The symptoms correlated with the location of the intracranial abnormalities. The literature is reviewed and the pathophysiology of the lesion is discussed.

Aged↗
PubMed1990

Krypton laser-induced lens opacity as a complication of retinal photocoagulation.

Lens opacification is a well-documented complication of argon laser photocoagulation, particularly in eyes with preexisting cataracts. In eyes with media opacity, the krypton laser is frequently used for its superior penetrating qualities. To date, lens opacification from krypton application has not been documented. We report such a case in a cataractous eye with a vitreous hemorrhage undergoing panretinal photocoagulation. Factors previously implicated in the etiology of laser-induced lens damage were not present. The opacities were similar to those produced by the argon laser. We present a mechanism for understanding laser-induced lens damage and speculate on the difference between the interaction of argon versus krypton laser energy with lens constituents.

Cataract↗
PubMed1998

Role of REM sleep and dream affect in overnight mood regulation: a study of normal volunteers.

To test that REM sleep and/or dreaming aid in the overnight regulation of negative mood, 60 student subjects, selected to have no current or past episodes of depression, were tested with the Profile of Mood States (POMS) before and after two nights of laboratory sleep. There was a significant overnight effect of sleep on the Depression scale (Dep) both on a sleep-through night and a night of REM awakenings for dream recall. Pre-sleep Dep was significantly correlated with the affect in the first REM report. Although Dep scores were truncated due to the screening criteria, a subgroup of the 10 highest scorers differed from the 50 low scorers in the distribution of dream affect categories across the night. Low scorers displayed a flat distribution of positive and negative affect in dreams, while those with some pre-sleep depressed mood showed a pattern of decreasing negative and increasing positive affect in dreams reported from successive REM periods. This suggests that dreaming may actively moderate mood overnight in normal subjects.

Adult↗
PubMed1989

Laparoscopic treatment of ectopic pregnancy.

Over the last decade and a half the success and safety of endoscopic surgery for ectopic pregnancy has been established. Shapiro and Adler (1973) reported laparoscopic salpingectomy using electrocoagulation followed by excision. Soderstrom (1981) followed with the snare technique of salpingectomy. Valle and Lifchez (1983) reported tubal patency rates approaching and attaining 100% following salpingostomy in the sole oviduct during laparotomy encouraged continued laparoscopic approach. DeCherney (1981) described linear salpingostomy via a cutting current in 18 women with an intrauterine pregnancy rate of 50% 1 year afterwards. No spontaneous abortions or repeat ectopics were reported. Pouly et al (1986) described laparoscopic salpingostomy in 321 women with a resultant 64% intrauterine pregnancy and 22% repeat ectopic rate. These studies support the realization that previous surgical approaches per laparotomy for ectopic pregnancy may be achieved endoscopically, but intraoperative and postoperative complications have occurred. As noted by Kelly et al (1979) and Richards (1984) these consist mainly of persistent or delayed haemorrhage along with continued trophoblastic growth. Haemorrhage is most often a result of failed salpingostomy in larger ectopics. Continued trophoblastic development requiring repeat surgical exploration due to incomplete removal of tissue has been reported by Pouly (1986) in as many as 5% of cases. This rare but reported consequence signals the importance of following quantitative HCG concentrations into the negative range. Occasionally HCG levels remain elevated more than 30 days postoperatively with eventual resolution; Cartwright et al (1986) claim that tubal patency rates appear to be unaffected by this prolonged clearance of tissue. Despite infrequent morbidity, laparoscopic treatment of ectopic pregnancy, in comparison to laparotomy, significantly shortens hospital stays, operating time, convalescence and postoperative analgesic requirements (Brumsted et al, 1988). Endoscopic surgery also reduces postoperative formation of pelvic adhesions (Fayez and Schneider, 1987). As familiarity and technical expertise with endoscopy continues to increase, exploratory laparotomy may be considered too radical an approach to ectopic pregnancy treatment regardless of the procedure performed.

Female↗
PubMed2004

Bladder cancer in patients with spinal cord injuries.

OBJECTIVE: To evaluate the age-standardized incidence rate of bladder cancer in patients with spinal cord injury (SCI) and the overall risk for this population. PATIENTS AND METHODS: We reviewed 1334 patients with SCI whose dates of SCI, or first attendance at our centre, were between 1940 and 1998. The length of follow-up was calculated for each patient and age-specific incidence rates of bladder cancer calculated using 5-year age bands. This was used to calculate the overall incidence rate, using direct standardization with the European standard population. The cancers were analysed histochemically to characterize the phenotype. RESULTS: The 1324 patients contributed a total of 12 444 person-years of follow-up. There were four cases of bladder cancer, giving an age-standardized incidence rate of 30.7 per 100 000 person-years. Histochemistry showed areas were positive for cytokeratin 14, which was also positive in the undifferentiated areas. Immunohistochemical staining was positive for cytokeratin 14 and consistently negative for cytokeratin 20, suggesting a pure squamous phenotype. CONCLUSIONS: The age-standardized incidence of invasive bladder cancer in patients in our SCI unit is not statistically different from that of the general population. However, the incidence of invasive bladder cancer in the present study appears to be lower than that reported in other series. Histochemical analysis confirmed a squamous cell phenotype in these tumours.

Adult↗
PubMed1985

Synovial cyst of a cervical facet joint: case report.

Intraspinal synovial cysts are rare. Those reported have occurred in the lumbar region. We report a case of an extradural true synovial cyst of the cervical spine causing spastic paraparesis. The cyst occurred after a cervical spine fracture and, hence, was probably related to trauma. Surgical therapy resulted in a satisfactory recovery.

Adult↗
PubMed2002

The narcissistic exoskeleton: the defensive organization of the rage-type murderer.

After outlining the characteristics of rage-type murder, the author reviews possible psychodynamic explanations of the predisposing personality and the act itself. He argues that more recent contributions, using an object relations perspective, best account for the complexity of the internal world of these offenders. Using a single case to illustrate observations drawn from his work with nine offenders, the author sets out to develop an understanding of the defensive organization present in these apparently normal murderers. He isolates a defensive system comprising a set of split object relations that correspond with a split between internal and external reality, which he calls the "narcissistic exoskeleton." Projective and introjective processes that support the defensive organization are discussed. It is suggested that such a profile typifies a particular kind of stable borderline personality organization.

Adult↗
PubMed2004

Anticipatory interpretations: addressing "cautionary tales" and the problem of premature termination.

This article explores the use of anticipatory interpretations early in the therapeutic process as a means of addressing the problem of premature termination with some patients. The author argues that emerging transference references, detected through a close attention to "cautionary tales" or derivative communications, should be used in early interpretive interventions. It is suggested that such transference references form a "template of intention" that help determine future difficulties in the therapeutic alliance. Being able to communicate these observations in a future-orientated way lays the groundwork for "thinking about" actions that threaten the therapeutic alliance when they occur, in turn curtailing the possibility of acting out through termination. The author uses two case examples to illustrate his observations and goes on to suggest that anticipatory interpretations involve: (1) isolating derivatives and underlying anxieties, (2) future-orientated transference references, and (3) an affirmation of difficulty.

Adult↗
PubMed1991

Leber's idiopathic stellate neuroretinitis.

Leber's idiopathic stellate neuroretinitis, originally known as Leber's stellate maculopathy, is an uncommon syndrome characterized by unilateral optic disc swelling followed by the development of a macular star due to leakage of capillaries within the optic disc. It is seen in patients 50 years of age or younger and usually resolves spontaneously without visual sequelae. This entity should be recognized and distinguished from more serious diseases causing septic neuroretinitis or papillitis. We present a case which was initially thought to be septic retinitis.

Adult↗
PubMed1989

Segmental mediolytic arteritis. A clinicopathologic and ultrastructural study of two cases.

We describe the histopathologic and ultrastructural changes in two cases of segmental mediolytic arteritis (SMA) and summarize the clinical and pathologic findings in previous reports. SMA is initiated by the transformation of the arterial smooth-muscle cytoplasmic contents into a maze of dilated vacuoles containing edema-like fluid. With vacuolar rupture, the smooth-muscle cells are disrupted and the mediolytic process completed. Mediolysis is accompanied by fibrin deposition and hemorrhages at the adventitio-medial junction and within the media. Inflammation is inconstant and limited to the periadventitial tissues. Transmural mediolysis leads to the formation of arterial wall gaps--defects in the vascular wall bridged by a serofibrinous layer. The serosal and intramural arteries and arterioles of the jejunum and the epicardial coronary arteries were the targets of SMA in this report. SMA occurs in two clinical settings: (a) in abdominal muscular arteries and arterioles of predominantly elderly patients presenting either with ischemic bowel disease or shock, and (b) in the coronary arteries of neonates in conditions associated with severe hypoxemia. We conclude that SMA is the result of an inappropriate vasospastic response expressed in a splanchnic vascular bed undergoing vasoconstriction as a response to shock or severe hypoxemia.

Aged↗