Illness-specific control issues in patients with vertigo as the main symptom

The study explored the relationship between health locus of control and anxiety in 90 patients with the chief complaint of dizziness/vertigo. The patients were subjected to a neurological examination, including standardised history, physical examination, electronystagmography with caloric testing and posturography, auditory and visually brainstem-evoked responses, masseter reflex, vertebrobasiliar transcranial Doppler, optional: cranial imaging (CCT/MRI), cardial diagnostic, and a psychiatric-psychodynamic examination (including psychometric tests: STAI-G X2, KKG, SBA-S). The whole group of patients (psychogenic and organic dizziness) had a specific pattern of health locus of control: "double health external" (Type IV-Wallston and Wallston 1982). Patients with psychogenic dizziness showed a higher score of external locus of control (chance) compared with the patients with organic dizziness. High anxiety scores were accompanied by high scores of external locus of control (powerful others and chance) above all in the patients with psychogenic dizziness. Implications for therapy are discussed.     

Carboxylic ester hydrolase and amylase in ischemic pancreatitis in the guinea pig

OBJECTIVES: To define the clinical, neuropsychological, and radiological features of bilateral parietal lobe atrophy. METHODS: Four patients underwent a comprehensive longitudinal neuropsychological assessment, as well as MRI and HMPAO-SPECT. RESULTS: The consistent findings in the patients were early visuospatial problems, agraphia of a predominantly peripheral (or apraxic) type, and difficulty with bimanual tasks, all of which outweighted deficits in memory and language until later in the course of the illness. As the disease progressed, impairments in the phonological aspects of language and in auditory-verbal short term memory were often striking, perhaps reflecting spread from the parietal lobe to perisylvian language areas. Three patients went on to develop a global dementia and fulfilled the criteria for a clinical diagnosis of probable Alzheimer's disease; the fourth patient has only recently been identified. Neuroimaging disclosed bilateral parietal lobe atrophy (MRI) and hypoperfusion (SPECT), which was out of proportion to that seen elsewhere in the brain. One patient has died and had pathologically confirmed Alzheimer's disease with particular concentration in both superior parietal lobes. CONCLUSIONS: Bilateral biparietal atrophy is a recognisable clinical syndrome which can be the presenting feature of Alzheimer's disease. Although the label "posterior cortical atrophy" has been applied to such cases, review of the medical literature suggests that this broad rubric actually consists of two main clinical syndromes with features reflecting involvement of the occipitotemporal (ventral) and biparietal (dorsal) cortical areas respectively.     

When a physician makes a mistake

Inevitably, doctors make mistakes in the normal course of providing care. Making a mistake often causes distress for the doctor involved, but it can also be an important source of knowledge and self-reflection. This article discusses central aspects with respect to mistakes and medical malpractice. The doctor's relationship to ethics and legislation is discussed, and an overview of the administrative action taken by the Norwegian health authorities is presented. The organisations and offices a physician may come into contact with when involved in a patient's complaint are briefly presented. "Meldesentralen" was formed in 1993 by the Norwegian Directorate of Health for the purpose of collecting reports on accidents in medical practice. We argue that the accidents reported to "Meldesentralen" do not reflect the true situation on this issue. We introduce a model for a systematic approach towards a colleague who has made a mistake or who is suspected of having made one.     

Oral tegafur in the treatment of metastatic breast cancer: a phase II study

Between February 1985 and October 1989, 26 patients previously treated for metastatic breast cancer received oral tegafur, at a median daily dose of 1200 mg. Of these, 21 were evaluable for response. The overall response rate was 29%; six (two in lungs, two in skin and two in lymph nodes) of 44 evaluable lesions (14%) responded to therapy. Haematological toxicity was mild, and no other dose-limiting toxicity was seen. The data indicate some activity in heavily pretreated metastatic breast cancer even after previous 5-FU therapy.     

Ectopic pregnancy involving the rectum

A case of advanced extrauterine pregnancy involving the rectum and with passage of fetal limb through the anus is presented. The patient probably had a heterotopic gestation.     

Effects of heating rate and DC electric field during sintering on the grain size distribution in fully sintered tetragonal zirconia polycrystals stabilized with 3% molar yttria (3Y-TZP)

The effects of sintering temperature rate ([(T)\dot] (\dot{T} = 1.5–50 °C/min) without and with an initial applied dc electric field (E _o = 14 V/cm) on the grain size distribution (GSD) of fully sintered 3 mol%, yttria-stabilized tetragonal zirconia (3Y-TZP) was determined from SEM micrographs of fractured and polished-and-etched surfaces. No clear difference between the measurements on the two surfaces was detected. The grain size parameters characterizing the GSD tended to decrease with [(T)\dot] \dot{T} and with E _o. All of the GSD’s however fit a single curve based on the Bitti–Di Nunzio grain coarsening model. This fit along with other considerations also give that the heating rate and electric field applied during sintering did not have a significant effect on the grain shape or the grain boundary energy in the fully sintered specimens. It is proposed that the decrease in grain size in the fully sintered condition by the application of an electric field during prior sintering results primarily from its effect on the driving force for grain growth, while the effect of the heating rate is on the grain mobility.     

Animal models for studying serotonin (5-HT) receptor subtypes: relationship to 5-HT system pathologies

Despite more than 30 years of intensive research, the specific role of serotonin (5-HT) receptor subtypes in animal models of "anxiety" still remains unclear. The present study focused on the particular role of 5-HT1A receptor subtype in aversive learning, i.e., the passive avoidance (PA) task in the rat. Taken together, the data strongly suggest that: (1) 5-HT1A receptor but not 5-HT2A receptors play a crucial role in PA; (2) the postsynaptic but not presynaptic 5-HT1A receptors are mainly involved in the regulation of PA; (3) 5-HT1A receptors appear to be directly involved both in acquisition and retrieval but not in the consolidation of PA; and (4) besides the "prototypical" 5-HT1A receptor subtype, an additional and yet-unidentified 5-HT receptor subtype seems to play an important modulatory role in PA.     

Effects of Ginkgo biloba extract on the cochlear damage induced by local gentamicin installation in guinea pigs

Results from the CMA's 1998 Physician Resource Questionnaire are in, and they point to a serious decline in physician morale. The PRQ, the country's most important poll of physician attitudes, provides an annual "state-of-the-nation" message for the medical profession.     

Coping with illness in myasthenia gravis in comparison with other chronic neuromuscular diseases

Seventy-nine patients with chronic neuromuscular diseases were examined by psychodiagnostic tests. The most frequently used coping strategies were "compliance and confidence in the physician", "self encouragement", "to relative by comparison" and "problem-solving". Comparison of the test sample and our total sampling group and the groups divided by diagnosis showed more common features than differences in the coping process. This might be caused by similar general problems in chronic diseases. Less "compliance and confidence in the physician" was the only significant difference between the myasthenic patients and the remaining test group. We supposed less treatment possibilities and/or longer duration of illness (remaining test group) to be responsible for this result. Duration of illness in common seems to have an influence on coping. Patients suffering a longer illness showed reduced values in "self encouragement". Common and specific problems and circumstances of illness seem to be more significant for the coping process than the diagnosis. The patients' mood, which we took as a measure for partial aspects of adaptivity of coping, correlated significantly with the strength of the complaints felt. Classification into adaptive and maladaptive coping forms is not possible.