Indications and methods for compression distraction osteosynthesis (author''s transl)

The roentgen appearance and pathogenesis of carpal instability are described in an evaluation of patients and cadavers with rheumatoid arthritis and calcium pyrophosphate deposition disease. Dorsiflexion (16%) and palmar flexion (8%) instability occurs in rheumatoid arthritis, particularly in patients with moderate to advanced disease. Navicular-lunate dissociation frequently accompanies dorsiflexion instability and results from involvement of the interosseous ligament between the two bones by rheumatoid pannus. Carpal instability and navicular-lunate dissociation also accompany pyrophosphate arthropathy, resulting from calcific deposition and cystic degeneration of ligamentous structures.     

The dangers of dextropropoxyphene

OBJECTIVE: Dextropropoxyphene is a commonly used analgesic despite its high toxicity in overdose and potential for abuse and dependence. This case report highlights these dangers. CLINICAL PICTURE: The case of a female who was addicted to dextropropoxyphene as an alternative to other opioids is described. Its use in high doses with other psychotropic agents resulted in adverse health effects. TREATMENT: The patient was treated with methadone and psychosocial interventions. OUTCOME: The patient reduced her drug use and experienced improved physical health and psychosocial functioning. CONCLUSIONS: Caution is needed when prescribing dextropropoxyphene because of its adverse effects compared with equally efficacious analgesics.     

The dynamics and dangers of entitlement.

Excessive entitlement can accompany a range of other problems presented by patients encountered in psychotherapy. In its problematic form it is conceptualized here as having roots in emotional deprivation in childhood, especially when the child was used as a narcissistic extension by parents. This "special" role becomes a learned attitude and behavior and a refuge and defense against the hurt, shame, and fear resulting from this experience. Anger and vindictiveness provoked by this coercion and deprivation can reach dangerous, murderous proportions, with defensive entitlement demanding redress and revenge. A journalistic account illustrative of these unfortunate consequences is provided and interpreted. Psychodynamic treatment of excessive entitlement in an obsessive-compulsive patient, using an object relations approach, is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dangers of taking ''T in the country''

'T in the Park' is the largest annual music festival in Scotland. This paper reports on how an increased attendance and change of location for the 1997 event altered the workload. The influences that affected the pattern of patient presentations and the adaptations made in the medical service provided are discussed.     

The dangers of long-term catheter drainage

There are many dangers associated with long-term urinary bladder drainage by catheter. For various reasons, the choice of catheter is important, and its initial insertion can be particularly hazardous. All catheterizations should, however, be safer when there is some urine (or other fluid) in the bladder. The appropriate choice of drainage system attached to the catheter can delay bacterial invasion of the bladder. Great care is needed to prevent blockage of the system, particularly when bacteriuria is present. Recent evidence indicates that some bacteria encourage the development of encrustations, so that, in some circumstances, catheters may become blocked within 24 hours. This, together with other considerations, strongly suggests that indwelling catheters should be changed at intervals of not more than 5 days. The practical implications of this are considered, as are the benefits that may accrue. Accidental catheter traction is another danger, and some possible methods of avoiding this are discussed. Finally, the need for a new kind of drainage-bag support is highlighted.     

Physician-assisted suicide: the dangers of legalization

The authors examine physician-assisted suicide in the light of what is known about suicide and terminal illness, exploring the potential for abuse if legalization occurs. The elderly, those frightened by illness, and the depressed of all ages would be potential victims. The authors discuss the cases that have received public attention as illustrative of these abuses.