Popliteal pterygium syndrome in a 74-year-old woman

The case of a 74-year-old woman with the rare popliteal pterygium syndrome is presented. This syndrome is inherited as an autosomal dominant trait with incomplete penetrance and varying expression and consists of cleft lip and palate, lip pits, genital anomalies, popliteal pterygium, and malformations of the extremities. The various treatments our patient underwent over the years are reported. Treatment of popliteal pterygium involves special problems whem removing the skin fold because the nerve and vascular cords lie immediately anterior to the posterior fibrous cord. In the present case there are widespread arthrotic changes, both in the extremity joints and in the spine. These patients are short in stature. This, together with the general arthropathy, suggests a hereditary metabolic disturbance in the cartilaginous tissue.     

Syncope in a 65-year-old woman after nitrate ingestion

A 65-year-old woman with angina pectoris presented with syncope after sublingual ingestion of isosorbide dinitrate (5 mg). Her response to a postural challenge test, without medication, was normal. In a postural challenge test after administration of isosorbide dinitrate (5 mg), blood pressure decreased from 120/67 to 65/35 mmHg, followed by syncope with a sudden decrease in pulse rate from 85 to 60 beats/min. No evidence of myocardial infarction was detected. Elderly patients for whom nitrate has been prescribed should be warned of the occurrence of hypotension, leading to unconsciousness.     

Endodermal sinus tumor and embryonal carcinoma of the ovary in a 53-year-old woman

BACKGROUND: Germ cell tumors, the most common ovarian malignancies in females under the age of 21, are rare in older women. We report an unusual case of a mixed embryonal carcinoma and endodermal sinus germ cell tumor in a perimenopausal patient and review the differential diagnosis and management of these malignancies with respect to age. CASE: A 53-year-old woman complaining of irregular menses and pelvic pain was found to have a large pelvic mass and a positive pregnancy test. Subsequent investigation revealed a large left adnexal mass, and an elevated beta-HCG and alpha-AFP. At laparotomy, a mixed germ cell tumor was found. The patient was treated with multiagent chemotherapy and currently is without evidence of disease. CONCLUSION: Although rare, the diagnosis of germ cell tumor should be considered in older women presenting with a large pelvic mass. The treatment and prognosis is similar regardless of age, except that reproductive-sparing surgery is not a priority in the older patient.     

Acute intravascular haemolysis with massive microspherocytosis in a 75-year-old woman

Acute intravascular haemolysis (AIH) sometimes occurs in patients with sepsis or bacteraemia, mainly due to clostridia or Salmonella sp., and may be a life-threatening condition. We describe a case of AIH in a 75-yr-old woman with chronic cholelithiasis. Blood and stool cultures were repeatedly negative, but the massive microspherocytosis, typically observed in clostridia infections, oriented our diagnosis. The patient was treated with antibiotics and for a rapid worsening of her conditions, which could have led to the onset of a multi-organ dysfunction syndrome (MODS), with plasma exchange and, subsequently, haemodialysis, with satisfactory results.     

Sandtray therapy with a 24-year-old woman in the residual phase of schizophrenia.

Sandtray therapy is a clinical tool for helping a client express and understand his or her unconscious dynamics. It utilizes a sandtray and anywhere from a few hundred to a few thousand figurines in the room for the client to select from. These figurines cover a wide range of people, situations, and objects, from the most ordinary to the mythical. The client makes a story in the sand, which the client and therapist then discuss. It is standard therapeutic wisdom that one should not use techniques involving fantasy with psychotic clients since it is typically too hard for both them and the clinician to contain those fantasies in a healthy manner. Although this is very often true, the authors offer an example of how they were able to use sandtray to great therapeutic advantage with a schizophrenic client in the residual phase of schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)