Communication with parents of children with cancer

The authors summarize the results of recent work evidencing the existence of latent merozoites during the course of the erythrocytic cycle of the rodent Plasmodia. These merozoites, unlike the majority of merozoites released at schizogony, do not penetrate immediately into the erythrocytes and remain latent for a variable length of time. The merozoites of each of the species or subspecies show marked peculiarities which are responsible for the characteristics of their cycle. The presence of latent merozoites free in the blood, the asynchronous development, and the resistance to chloroquine, are three closely related factors. Knowing that the merozoite is so far drug resistant, and that latent merozoites can maintain the infection for any length of time, it appears important to take into account these purely biological data, when studying the drug resistance of the human falciparum malaria.     

A case of migraine with aura associated with meningioma

We reported a case of migraine with aura associated with meningioma. A 66-year-old female visited to our department in 1985, with occipital throbbing pain following visual hallucination and nausea. She had been diagnosed as migraine. CT scan, magnetic resonance image and angiography showed a right occipital tumor, which was totally removed in 1990. Postoperatively, the migraine disappeared completely. The tumor was histologically diagnosed as fibroblastic meningioma. We supposed that the migraine had been associated with meningioma. Although some previous papers reported correlation with brain tumor and migraine, as example of arteriovenous malformation or angioma, migraine associated with meningioma is very rare. In arteriovenous malformation, pathophysiology of migraine is unclear, but induction of circulatory disturbance in the distribution of the posterior cerebral, posterior communicating and basilar artery is supposed. And then a space occupying lesion in the occipital lobe is possible to cause in the circulatory disturbance of the posterior cerebral and basilar artery. In the diagnosis of migraine, we should consider its relation to brain tumors, such as meningioma.     

Remission of schizophrenic psychosis with negative symptoms with risperidone

The appearence of extrapyramidal motor disorders and the inadequate response of the negative symptoms to classical neuroleptic treatment represent a serious impairment for the patient that make rehabilitation and reintegration into the work setting difficult or even impossible. Such patients can profit from a changeover to risperidone, which has a more favorable side effects profile and an appreciably better effect on the negative symptoms than classical neuroleptics. The therapeutic usefulness of risperidone treatment is illustrated by the case of a 27-year-old technician whose pronounced negative symptoms failed to respond to classical neuroleptic treatment.     

Treatment of patients with chronic pulmonary tuberculosis with expectoration--evaluation of effectiveness

Two patients with multidrug-resistant pulmonary tuberculosis were surgically treated after 3 and 7 years of unsuccessful chemotherapy. There was pneumonectomy in one case and lobectomy with segmentectomy in the second. Pneumonectomy was complicated by bronchopleural fistula. Both patients become sputum culture negative after surgical treatment but first patient died 5 months after surgery because of acute hepatitis.     

Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws

We retrospectively reviewed the results for thirty-four patients in whom a non-union of the scaphoid had been treated with bone-grafting and internal fixation with use of one of two types of screws as well as the temporary placement of Kirschner wires parallel to the screw to prevent rotation. The patients were divided into two groups: Group 1 contained sixteen patients who had been managed with a Herbert screw from 1986 through 1989 and Group 2, eighteen patients who had been managed with a 3.5-millimeter cannulated AO/ASIF screw from 1990 through 1992. There were no clinical or radiographic differences between the two groups. The time to union, confirmed with tomography, was 7.6 +/- 3.6 months for Group 1 and 3.6 +/- 1.2 months for Group 2. This difference was significant (p < 0.01). Both screws significantly improved the alignment of the scaphoid and decreased carpal collapse (p < 0.05). Regardless of the type of screw used, the time to union was significantly shorter when the screw had been placed in the central one-third of the scaphoid (p < 0.05). Seventeen of the eighteen cannulated screws had been placed centrally, compared with seven of the sixteen Herbert screws (p < 0.01).     

Injection pain with propofol. Reduction with aspiration of blood

A randomised, controlled, single-blind study was performed on 100 patients to investigate a new method of reducing pain on propofol injection. Aspiration of 2 ml of the patient's blood into a syringe of propofol immediately before injection was compared with the addition of lignocaine 20 mg or normal saline 2 ml to the propofol before injection. The addition of blood was significantly more effective in reducing pain on injection than the addition of saline (p < 0.001), but was not significantly more effective than the addition of lignocaine.     

Treatment of pancreatic stones with extracorporeal lithotripsy with sonographic localization

BACKGROUND: Pancreatic stones may be treated by endoscopic extraction or by surgery. Extracorporeal shock wave lithotripsy increased possibility of noninvasive steps to their elimination. The aim of this study was to describe our first experience with this method. METHOD AND RESULTS: 10 patients (6 men and 4 women) in average age 47 years (between 19 to 72 years) were treated. The lithotriptor MEDILIT with sonographic targeting was used for fragmentation of pancreatic stones. Fragmentation was achieved in 8 patients, in 4 cases we observed spontaneous disappearnace, in 3 cases an endoscopic extraction of fragments was necessary. In one case good fragmentation was observed at control ECRP, but the repeated Wirsungography showed a big pseudocyst which had not been diagnosed at the first examination and surgery was necessary. In 2 cases no fragmentation was achieved and in these cases surgery was also indicated. No serious side effects were observed, nor elevation of amylase values compared with the situation before the shock wave treatment. CONCLUSIONS: Extracorporeal shock wave lithotripsy of pancreatic stones revealed good fragmentation and disappearance stone from ductus Wirsungi without serious side effects on clinical course and surrounding soft tissues.     

Building partnerships with parents of school-age children with communication disorders

Benign lymphoepithelial cysts (BLC) are rare disorders of salivary glands (0.6%). In patients infected by HIV, they are seen more often. In comparison to sporadic BLC, the patients are younger, the diameter of the cysts is up to 5 cm and they are often located bilaterally. At the Department of ENT, Head and Neck Surgery of the Ludwig-Maximilians-University, Munich, ten HIV-infected patients (two females) showed lymphoepithelial cysts (six times bilaterally). One of these revealed a metastasis of a small cell neoplasma near the cysts, another patient showed a non-Hodgkin's lymphoma of low grade malignancy (MALT-type), and one patient additionally had bilateral Warthin's tumours. The BLCs were mostly located in the parotid tail. In three cases, the cysts were found on the inferior border of the parotid and once at the submandibular gland. The age ranged from 27 to 71 years (medium 45.7 years). The mode of HIV infection was homosexuality five times, drug abuse twice, heterosexuality once, and blood products once. In two cases, the channel of transmission was unknown. The majority of the patients showed minor HIV illness (CDC II [n = 2]/CDC III [n = 4]); the rest had advanced immunodeficiency (CDC IV [n = 4]). All the cysts were examined by ultrasonography and NMR. According to the clinical findings and the general stage of health, BLCs were either enucleated (n = 8) or a superficial parotidectomy (n = 5) and selective biopsy of lymph nodes (n = 3) suspected to be malignant were performed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Re-treatment with interferon alfa of patients with chronic hepatitis C

Treatment of patients with chronic hepatitis C has had limited success because of relapses and nonresponse to interferon alfa therapy (currently the only established therapeutic agent). A retrospective study was done to determine the efficacy of re-treatment with interferon and the predictors of response in patients who failed to achieve sustained response after one standard course of interferon therapy (3 million units three times a week for 24 weeks). One hundred and eleven patients (47 relapsers and 64 nonresponders), mean age 45 years, were included in the study. Eighteen relapsers and 13 nonresponders received a higher dose (5 MU), and 11 relapsers and 6 nonresponders received a longer duration (48 weeks) of interferon therapy. The remaining patients received the same regimen as the first treatment. Eighty-one percent and 23% of relapsers and nonresponders, respectively, had an end-of-treatment response, and 19% and 3% of the corresponding patient groups had a sustained response to re-treatment. Two patients with breakthrough during their first treatment were the only nonresponders with sustained response after re-treatment. Sustained response was observed only in patients who received an increased dose or duration of interferon therapy. No predictor of sustained response was found. In conclusion, sustained response to re-treatment with interferon was only observed with augmentation of dose or duration of therapy in some relapsers and patients who had breakthrough. Established predictors of response to interferon in naive patients, in particular serum hepatitis C virus RNA and genotype, were not associated with sustained response to re-treatment.     

Treatment of hypertension with felodipine in patients with concomitant diseases

This paper suggests that continued high-risk behavior is the result of the heuristics used to make judgments under uncertainty, and that the same heuristics may be mobilized to increase the use of safer-sex practices. In order to explain why it is that individuals fail to make effective use of the information they may have concerning rates of infection, consequences of infection and their own at-risk status, theory and research in several areas will be considered. Developments in the breadth of areas to which basic research on decision-making has been applied continue to provide new approaches toward understanding and overcoming the processes by which we reason (Kahnemann, 1991). It is worth reminding ourselves that public health campaigns in other areas have led to changes in behavior. Reasoning, even with its biases, is still the route by which we make decisions, most of them effective and self-protective.     

铍共沉淀分离分光光度法测定金属铋中微量锡

在EDTA存在下,于氨性介质中,用硫酸铍作载体,使锡与主体铋分离,在0.5mol/L硫酸溶液中,用苯芴酮-十六烷基三甲胺光度法测定锡量.测定范围5×10-5%～5×10-4%,相对标准偏差为1.94%～2.38%.     

Induction of menstruation with bromocryptine in patients with euprolactinemic amenorrhea

Three nulliparous women presented with secondary amenorrhea with no evidence of endocrinopathy and normal skull x-ray. Pulsatile gonadotropin secretion was reduced, but an adequate pituitary gonadotropin reserve was demonstrable with luteinizing hormone-release factor provocation. The administration of bromocryptine was associated with amplification of pulsatile secretion of gonadotropins and was followed, in two of the three, by ovulatory menstruation. It is suggested that bromocryptine should be considered for induction of menstruation in euprolactinemic secondary amenorrhea.     

Psychotherapeutic issues with family members of persons with physical disabilities

The need for individual psychotherapy for family members of persons with physical disabilities is growing as medical interventions improve and survival rates increase. The family members' grief reactions are one part of the adjustment process. Psychological difficulties that develop are influenced by a number of considerations. The family member as psychotherapy patient is part of a family unit whose balance, functioning and development has been disrupted. Factors relevant to physical disability, family systems approaches, and psychodynamic theory are influential in the treatment. The extent and type of a relative's disability determines the practical and personal impact for the patient as does the relationship of the patient to the person with the disability. A spouse, parent, child or sibling will each experience different practical and emotional consequences within the context of his/her ages, stage of life, and culture. The circumstances of the onset of the disability, the quality of the relationship, and the psychodynamic balance within each person and within the relationship are important issues to consider. All of the above affect the meaning of the disability for each family member personally, interpersonally, intrapsychically, and within the family unit. Because of limited experience with these emotionally loaded issues, possibilities for countertransference are significant. Recommendation is made for increased exposure to the area of physical disability in the training of psychotherapists.     

Survival of patients with carcinoma of the esophagus treated with combined-modality therapy

Since 1985, 229 cases of carcinoma of the esophagus have been considered for entry into a protocol with the use of preoperative chemotherapy and radiation therapy followed by surgical intervention as the primary element of treatment. One hundred sixty-five patients (93 with adenocarcinoma and 72 with squamous cell carcinoma) had esophagogastrectomy. The 5-year survival of the protocol patients who underwent resection was 25% for both groups--squamous cell carcinoma and adenocarcinoma. Of the protocol patients with squamous cell carcinoma who underwent resection, 40% had a sterilized specimen, whereas of those with adenocarcinoma, 20% had a sterilized specimen. If the patient had a sterilized specimen, the 5-year survival was approximately 60% for adenocarcinoma and 40% for squamous cell carcinoma. Those patients with adenocarcinoma and Barrett's esophagus had a 5-year survival of 55%. Of the patients who underwent only esophagectomy and esophagogastrectomy and had not been entered into the protocol, none lived beyond 3 years. The operative mortality rate for those who had esophagogastrectomy was 5%. Sixty-four patients completed the radiation therapy and chemotherapy but did not undergo surgical procedures because of progressive disease or refusal. Of those patients who completed chemotherapy and radiation therapy without surgical intervention, 5-year survival was 18% in patients with squamous cell carcinoma, whereas no patients with adenocarcinoma survived beyond 3 years. The finding of a sterilized specimen after esophagectomy is a favorable prognostic factor in patients with adenocarcinoma or squamous cell carcinoma. The finding that patients with Barrett's esophagus and adenocarcinoma have an improved chance for survival is perhaps related to an earlier diagnosis. It is clear that some patients with squamous cell carcinoma who did not undergo surgical procedures did have a sterilized specimen, because the survival in this group approached 20% at 5 years.     

Treatment of patients with psychogenic amnesia with the help of therapeutic anamnesis

Psychogenic (dissociative) amnesia is a psychiatric disorder characterised by a sudden loss of memory which is too extensive to be explained by ordinary forgetfulness, but which has no organic disease or explanation. Psychogenic amnesia is categorised among the dissociative disorders in DSM-IV and ICD-10 and begins suddenly, usually after severe psychosocial stress. The prognosis is good with complete recovery, and there is seldom relapse. This article describes a man, 45 years of age, who developed severe depression and amnesia following a very troublesome divorce. He did not talk, he communicated by signs and gestures, and he isolated himself in his mother's home. After being admitted to a psychiatric ward he became anorectic and developed erosive eoesophagitis/gastroduodenitis. Initially he was given perfenazin (Trilafon) 24 mg/day. The psychiatric treatment produced no results for the first three weeks, but the patient gradually recovered when the therapist and the patient recapitulated the conflicts associated with the divorce, using documents from the patient's lawyer as a guide. This method is called "therapeutic anamnesis" and is similar in many ways to psychiatric treatment of post-traumatic stress reactions.