1/4. Case of multiple myeloma mimicking an infectious disease with fever, intrahepatic cholestasis, renal failure, and pulmonary insufficiency.We describe a case of multiple myeloma (MM) presenting with high fever, inflammatory chemistry abnormalities, simultaneous acute renal failure, cholestatic hepatitis, and acute lung failure. The extremely aggressive course and pulmonary involvement in the form of pulmonary alveolar proteinosis (PAP) are discussed, stressing the unusual nature of the findings and the variable picture of MM.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/4. The response of one primigravida to the situation of persistent anemia during pregnancy.This descriptive longitudinal case study examines the nature and purposes of the responses of one primigravida to the situation of persistent anemia during pregnancy. Selected literature in the following topic areas relevant to pregnancy complicated by serious illness is reviewed: stress, adaptation, defense and coping; pregnancy, illness and uncertainty; and body image implications of pregnancy and blood loss. Following unstructured interviews and observations in natural settings, process recordings were prepared and analyzed by the nurse-investigator to identify major behavioral themes. After repeated analysis and refining of categories, six mutually exclusive groups of responses were defined, and their frequency of use calculated: conditional compliance (34%), expressing affective states (24%), monitoring (23%), using support (11%), replenishing (5%), and using knowledge (3%). The subject used these responses, singly or in combination, to deal with various elements of perceived threat inherent in her anemic condition, the treatment of that condition, and her relationship with caregivers. The findings reveal one person's creative use of resources (inner and environmental) to develop a flexible response pattern effective in limiting or preventing stress associated with a potentially life-threatening condition.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/4. Acquired haemoglobin H disease, complicating a myeloproliferative syndrome: a case report.A case of acquired haemoglobin H disease in association with a myeloproliferative disorder is described. Severe haemolysis with hypochromic microcytic anaemia was present. Haemoglobin H formed 18% of the circulating haemoglobin and 60% of the red cells showed multiple inclusions on incubation with brilliant cresyl blue. blood film and absolute red cell values from a previous unrelated illness were normal, proving the acquired nature of the haemoglobin abnormality. Alpha/beta chain synthesis was measured in vitro and the degree of imbalance (alpha/beta ratio 0.39) was similar to that seen in the inborn thalassaemic disorder. A small proportion of red cells showed i-antigen reactivity but their haemoglobin H content was no different from the majority of cells which were l-antigen positive.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/4. Complications following gastric surgery in children.Although the diagnosis of peptic ulcer disease may be difficult in the pediatric age group, this problem is being faced increasingly by the physicians charged with the care of these children. Chronicity of symptoms has been documented in over 50 per cent of the patients demonstrating early peptic ulcers and therefore an aggressive approach to management has been advocated. Although the numbers are small, postgastrectomy syndromes of mechanical and nutritional nature appear less common in the young patient than in adults. Satisfactory growth and development are reported in nearly all series of patients followed after various gastric procedures. Both pyloroplasty and vagotomy and vagotomy and antrectomy appear to be extraordinarily well tolerated by the pediatric patient. Experimental evidence suggests that these patients should enjoy normal growth and development.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |