Case history: case number 5.
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Heart Arrest↗
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The case history.
Case histories report the basic data of psychoanalysis, and yet they are strikingly infrequent in the psychoanalytic literature. This reflects not only the methodological problems in describing psychoanalytic cases, but also the complex intentions of psychoanalysts who want both to present and to conceal aspects of their work. The history of the case history is discussed, as are the nature and purpose of case reports, the differences between oral and written reports, the relation between case reports and psychoanalyses, and case reports as countertransferential enactments. A plea is made for including authorial intention as an explicit part of the report, rather than concealing it behind a scientific facade.
Humans↗
Diagnosis of reaginic allergy with house dust, animal dander and pollen allergens in adult patients. III. Case histories and combinations of case histories, skin tests and the radioallergosorbent test, RAST, compared with provocation tests.
Case histories alone and combined with the results of skin tests and/or the radioallergosorbent test (RAST) were compared with the results of provocation tests in 397 patients with asthma or allergic rhinitis. Case histories often turned out to be doubtful. The agreement between negative histories and negative provocation tests was 77% and that between positive histories and positive provocation tests 64%. When case histories were supported by concordant skin test or RAST results, the agreement with provocation tests increased to about 90%. When a scoring system for the combinations of different diagnostic methods was employed, a 100% agreement with provocation tests was obtained for cases with high scores. It is concluded that by using the case history in conjunction with RAST and/or skin test results, a reliable diagnosis can be achieved, eliminating the necessity of provocation tests.
Allergens↗
"Patient" history vs. "Case" history.
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Foot↗
The erythrocyte sedimentation rate in general practice: clinical assessment based on case histories.
Thirteen case histories were mailed to 273 general practitioners to study the clinical assessment of the ESR. Participants were asked to state their reference limits for the ESR, as well as action values for the ESR in several clinical situations typical of primary care. The action value should represent the minimal ESR change from a given value necessary to initiate some kind of action towards the patient. The response rate was 76%. In most case histories, half the general practitioners reacted on an ESR change of 10 mm h-1 or less, which is usually due to analytical and biological variation, thus underlining the need for good analytical quality. In general the response was of the same magnitude irrespective of type of case history, i.e. whether the ESR was used in case finding, in diagnosis, or in follow-up. Estimation of the reference limit displayed considerable variation, and knowledge of a previous 'normal' ESR was of minor clinical importance. Furthermore, we found substantial variation regarding the change in ESR necessary to take action in different clinical situations. In principle, for many general practitioners the action value increased as the given ESR increased whereas others reacted on a constant change in ESR, or the change necessary to take action depended on the clinical situation. We conclude that both the different assessments as to the clinical significance of the ESR, and the unawareness of the significance of analytical and biological variation indicate that guidelines for rational use are needed.
Adult↗
Eva's stories: recognizing the poverty of the medical case history.
The medical case history is a proven tool for approaching the question "What is wrong with this person?" Its virtues, however, can become vices, in part as a consequence of the dehumanizing flight from sensitive subjectivity to sanitized objectivity, from human interest to "science." The case history, because it is so useful and effective, is not likely to be profoundly altered in the future, but medical educators can make themselves and their students more aware of the serious flaw in this form of discourse, i.e., the erasure of the unique individual from his or her disease. The exercise of asking medical students to abstract case histories from richly written short stories, novels, plays, or operas might heighten students' recognition of the poverty of the medical case history. To illustrate this idea, the story of Eva, a dying woman, is presented initially as a typical medical case history; it is then contrasted with excerpts from a novelist's narrative of Eva's life.
Aged↗
Counseling homosexual alcoholics. Ten case histories.
The case histories of 10 male homosexual alcoholics are presented, and psychoanalytic theories about the link between homosexuality and alcoholism are reviewed.
Adult↗
Jet-ski injury: a case history.
A case history is presented which involves a patient who sustained severe vaginal lacerations as a result of falling backwards off of a jet-ski. The surgical repair of the lacerations and postoperative course is discussed. An extensive search of the literature has failed to reveal any published reports of a similar injury.
Adult↗
Migrant sensory neuritis of Wartenberg. A case history.
A case history of a patient with a Migrant sensory neuritis of Wartenberg is presented. In this syndrome several isolated cutaneous nerves are affected, apparently due to traction lesions. This benign disease should be differentiated from other, more serious neurological diseases.
Adult↗
The matter of informed consent. A case history.
This case history outlines some of the difficulties in obtaining informed consent from a patient with a psychotic illness. It also makes reference to an array of other issues, for example, communication between professionals, the value of home visits, the need to be aware of medication side effects and the simple explanation for an apparently baffling clinical presentation.
Aged↗
Areawide chemical contamination. Lessons from case histories.
Nine case histories illustrate the mounting problems owing to chemical contamination that often extends beyond the workplace into the community. The effects include not only carcinogenesis and teratogenesis, so much in the public's mind, but also severe neurological and gonadal disabilities immediately after exposure. Recognition of causal relationships is often made by astute clinicians. The experience of the Atomic Bomb Casualty Commission in studying Japanese survivors in Hiroshima and Nagasaki serves as a model for future studies of communities exposed to unusual environmental contamination.
Adult↗
Multifocal central nervous system glioma--a case history.
A case history of the multifocal brain glioma in 13-year-old girl is reported. Numerous neoplasmatic foci were found using MRI within the vermis and cerebellar hemisphere and, later, also within the brain stem, cervical spinal cord and both brain hemispheres. Bioptical examination of the tumors revealed the structure of anaplastic astrocytoma with oligodendromatous component. The authors suggest that the foci may be considered as multiple metastases from the primary cerebellar astrocytoma and the neoplastic cells might have been transported within CNS through cerebrospinal fluid.
Cerebellar Neoplasms↗
Improving outcomes in therapeutic drug monitoring--a case history.
A case history describes quality improvement initiatives undertaken by the Laboratory, the Pharmacy, and the Department of Nursing at Children's Medical Center in Dallas, Texas, a 266-bed pediatric teaching hospital affiliated with the University of Texas Southwestern Medical School. The initial purpose of the study was to correct problems identified by a retrospective review of randomly selected patient charts. The problems included laboratory schedules for drug assays, the timing and documenting of blood collections, the reporting of toxic results to physicians, and the interpreting of serum drug concentrations. The major changes in the program included increased frequency of testing in the laboratory, educating nurses as to sample collection guidelines, introducing a clinical pharmacy consultation service, daily reporting of all drug levels to the pharmacy from the laboratory computer, and reporting toxic levels to the clinical pharmacist who then notified the physician and offered a consult. The study then began to focus on attempting to monitor the service related to outcome indicators. Outcome data included a comparison of test volumes (15.7% decrease), tests per adjusted patient day (15.4% decrease), and tests per patient day of therapy for aminoglycosides (gentamicin decreased 6.8%) before and after the changes were implemented. Data also included aminoglycoside tests reported as therapeutic and as toxic. Plans for further improvement have been identified and include differentiating peak and trough serum drug concentrations for aminoglycosides, possibly developing protocols for vancomycin and cyclosporine monitoring, continuing to educate laboratory technologists and nurses, and continuing to monitor usage and outcome indicators.
Clinical Laboratory Techniques↗
[A study of familial case histories of hepatocellular carcinoma--285 cases in Saga Prefectural Hospital].
We studied whether familial case histories of a liver cancers might be associated with the high mortality rate from liver cancers in Saga prefecture. Examined were 285 familial case histories of a hepatocellular carcinoma (HCC) incurred by parents, siblings, and children during the past 10 years. Familial case histories of patients with a gastric cancer and/or apoplexy also were studied as controls. The incidence of various types of cancers, including liver cancers and gastric cancers, in the family members of the HCC group was found to be the same as seen in family members of the gastric cancer group, but higher than in the families of the apoplexy group. Further, the HCC incidence rate in family members in the HCC group was not high as compared to the average for the whole of Japan. The HBsAg was not found to be associated with the rate of liver cancer in family members in the HCC group. Also, there was no high incidence of liver cancer was observed in children of parents with a liver cancer. From these results, we have concluded that high incidence of liver cancer seen in Saga prefecture was not associated with any familial clustering of HCC cases.
Adolescent↗
Case histories in forensic medicine.
Case histories make up a great part of publications in forensic medicine, especially forensic pathology, although considered low on the hierarchy of evidence based medicine because of its inherent anecdotal nature. Meanwhile some journals exclude case histories categorically from publication. The boom of case histories in forensic medicine has not only opportunity reasons (easily [even mental] and cheap to do) but also structural reasons: due to its tasks in case work many items of forensic medicine can not be simulated experimentally for ethical reasons (violent death, traumatic injuries, sexual assault, poisonings, influence of alcohol and drugs on driving ability and legal responsibility, medical malpractice, adverse events during medical care). In these fields the role of case histories is mainly the augmentation of experience based knowledge. However, quality aspects have to be considered and case histories should be the basis for systematic or hypothesis based research.
Forensic Medicine↗
[Documentation of urologic case histories by means of punched cards. Initial step toward computer case history].
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Austria↗
The misalliance dimension in Freud's case histories: i. The case of Dora.
This paper presents an effort to identify sectors of therapeutic misalliance between Freud and his patient Dora based on modifications in the framework of the analytic relationship and situation. Use is made of a template based on the current ground rules and boundaries of the patient-analyst relationship, and three deviations from this template are identified in Freud's analytic work with Dora. The intrapsychia and interactional sequelae of these deviations in technique for Dora and for the course of her analysis are traced out. The consequent sectors of misalliance are identified and the participation of both Dora and Freud is described, as are their respective, largely unconscious efforts to modify these areas of unconscious collusion. Stress is placed on Dora'a unconscious preceptions of the actual implications of Freud's modifications in the frame. The role of Freud's failure to rectify these deviations and to analyze their implications for Dora are considered, including their influence on the patient's premature termination of her analysis.
Attitude↗
[Critical comments on a case history "a death case involving tilidine" (author's transl)].
The author looks critically at the description of a suicide case involving a barbiturate dose that could not be determined exactly and doses of hydroxyzine and tilidine. Drugs with a short and a medium short duration of action obviously had the greatest effect. There was no description of an investigation of the gastric contents. The concentration of barbiturates in the blood alone was sufficient to cause death. The deceased also took hydroxyzine, and then finally 750 mg tilidine in capsule form. Tilidine's action is relatively slow in onset. The author discusses tilidine's possible contribution to the cause of death and comes to a different conclusion from the authors of the case report, especially as regards the key words "Tilidine--Intoxication". The authors of the case report ought to have called it "A Death Case Involving Barbiturates, Hydroxyzine and Tilidine" rather than giving is such a suggestive title as "A Death Case Involving Tildine". This would have been a more accurate representation of the facts and would have assisted the reader to grasp the complex toxicological situation more clearly.
Barbiturates↗