1/13. Asymptomatic rupture of an aortoiliac aneurysm.The rupture of an abdominal aortic aneurysm is one of the most feared complications confronted by cardiovascular surgeons. Such ruptures are usually catastrophic, but in some instances the rupture is posterior and remains sealed. These chronic ruptures may manifest with any of a variety of clinical presentations. This report describes an uncommon presentation of a chronic rupture of an aortoiliac aneurysm in a patient with generalized aneurysmal disease. The rupture presented as an asymptomatic giant pulsatile mass in the patient's abdomen. The mass had developed over a period of several years. The literature is also reviewed.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
2/13. Use of opioid analgesics in a patient with chronic abdominal pain.Pethidine is the most commonly used opioid in hospitals in the UK, but it lacks potency, has a short duration of action and a narrow therapeutic index. These points are illustrated by a case history of a patient prescribed pethidine for chronic abdominal pain. Misplaced fears of the side-effects of morphine result in its underuse in the management of chronic pain with consequential restriction of patients' functional ability.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
3/13. Non-compliance in adolescents with chronic lung disease: causative factors and practical approach.Compliance with medical therapies may be considered a challenge in many age groups but especially so in adolescence. The adolescent patient with chronic lung disease may struggle to progress smoothly through the phases of adolescence because of fears of peer rejection and isolation occurring as a result of social, emotional and physical consequences of their underlying lung disease and its treatment. Non-compliance can be viewed as a scale from episodic compliance to frequent compliance with patients moving between ends of the spectrum. health professionals need to consider the likely degree of compliance with therapies that they recommend, discuss the issue of compliance and the consequences of non-compliance with the adolescent patient and arrive at a workable compromise. This article discusses persistent asthma, cystic fibrosis and advanced neuromuscular disease to illustrate practical approaches to enhancing patient compliance in adolescence.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
4/13. Can pain-related fear be reduced? The application of cognitive-behavioural exposure in vivo.Although cognitive-behavioural treatments of patients with chronic pain generally are reported to be effective, customization might increase their effectiveness. One possible way to customize treatment is to focus the intervention on the supposed mechanism underlying the transition from acute to chronic pain disability. Evidence is accumulating in support of the conjecture that pain-related fear and associated avoidance behaviours are crucial in the development and maintenance of chronic pain disability. It seems timely to apply this knowledge to the cognitive-behavioural management of chronic pain. Two studies are presented here. Study 1 concerns a secondary analysis of data gathered in a clinical trial that was aimed at the examination of the supplementary value of coping skills training when added to an operant-behavioural treatment in patients with chronic back pain. The results show that, compared with a waiting list control, an operant-behavioural treatment with or without pain-coping skills training produced very modest and clinically negligible decreases in pain-related fear. Study 2 presents the effects of more systematic exposure in vivo treatment with behavioural experiments in two single patients reporting substantial pain-related fear. Randomization tests for AB designs revealed dramatic changes in pain-related fear and pain catastrophizing. In both cases, pain intensity also decreased significantly, but at a slower pace. Differences before and after treatment revealed clinically significant improvements in pain vigilance and pain disability.- - - - - - - - - - ranking = 8keywords = fear (Clic here for more details about this article) |
5/13. Chronic coccidioidomycosis infection of the knee: a case report.coccidioidomycosis is a rare fungal infection caused by C immitis in endemic areas of the southwestern united states. Extrapulmonary hematogenous dissemination is a feared complication of the primary pulmonary disease. The musculoskeletal system can be involved, and disseminated musculoskeletal infections can be extremely difficult to eradicate. Surgical treatment of chronic bone and joint infections includes debridement and eventual arthrodesis for end-stage secondary osteoarthritis.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
6/13. Ethical challenges in the management of chronic nonmalignant pain: negotiating through the cloud of doubt.After successful cancer pain initiatives, efforts have been recently made to liberalize the use of opioids for the treatment of chronic nonmalignant pain. However, the goals for this treatment and its place among other available treatments are still unclear. Cancer pain treatment is aimed at patient comfort and is validated by objective disease severity. For chronic nonmalignant pain, however, comfort alone is not an adequate treatment goal, and pain is not usually proportional to objective disease severity. Therefore, confusion about treatment goals and doubts about the reality of nonmalignant pain entangle therapeutic efforts. We present a case history to demonstrate that this lack of proportionality fosters fears about malingering, exaggeration, and psychogenic pain among providers. Doubt concerning the reality of patients' unrelieved chronic nonmalignant pain has allowed concerns about addiction to dominate discussions of treatment. We propose alternate patient-centered principles to guide efforts to relieve chronic nonmalignant pain, including accept all patient pain reports as valid but negotiate treatment goals early in care, avoid harming patients, and incorporate chronic opioids as one part of the treatment plan if they improve the patient's overall health-related quality of life. Although an outright ban on opioid use in chronic nonmalignant pain is no longer ethically acceptable, ensuring that opioids provide overall benefit to patients requires significant time and skill. patients with chronic nonmalignant pain should be assessed and treated for concurrent psychiatric disorders, but those with disorders are entitled to equivalent efforts at pain relief. The essential question is not whether chronic nonmalignant pain is real or proportional to objective disease severity, but how it should be managed so that the patient's overall quality of life is optimized. PERSPECTIVE: The management of chronic nonmalignant pain is moving from specialty settings into primary care. Primary care providers need an ethical framework within which to adopt the principles of palliative care to this population.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
7/13. Understanding the experience of hiv/AIDS for women: implications for occupational therapists.BACKGROUND: Within the past few years, hiv/AIDS has shifted from being an acute, palliative disease to one that is more chronic and episodic in nature. This shift has major implications for the role of occupational therapy in women's lives. Very few studies, however, have examined the perspective of women living with hiv/AIDS from an occupational therapy perspective. PURPOSE: This qualitative study was designed to examine the experiences of five women living with hiv/AIDS in Southern ontario and to begin to explore the implications of these findings for occupational therapy. METHOD: Through the implementation of five in-depth interviews, a phenomenological approach was used to explore the lived experience of women with hiv/AIDS. RESULTS: Four main themes emerged: fearing disclosure, experiencing challenges (physical and psychological), having supportive networks, and coping positively with being hiv positive (spirituality and opportunity for living and learning). PRACTICE IMPLICATIONS: There are several potential roles for occupational therapy in working with women who are living with hiv/AIDS More studies need to be pursued in this area of rehabilitation.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
8/13. Chronic bile peritonitis with progressive bile ascites: a complication of percutaneous biliary drainage.Percutaneous transhepatic biliary drainage procedures are associated with a small but definite incidence of complications. One of the most feared complications, leakage of bile, is commonly presumed to be a catastrophic clinical event. We present an unusual case in which a patient manifested only minimal abdominal symptoms associated with a massive biliary ascites. The bile leakage was first detected by diisopropyl iminodiacetic acid (DISIDA) scanning.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
9/13. Nephroscopy in chronic unilateral hematuria.Thirteen patients underwent renal exploration with nephroscopy to localize and to treat chronic unilateral gross hematuria. Recurrent episodes of clot colic were noted in 6 patients, 1 required multiple transfusions and persistent fears of cancer or problems with insurability prompted several patients to seek referral. All patients had undergone bleeding studies, urine culture, cytology, excretory urograms, retrograde pyelograms and selective renal angiography. These studies either were normal or failed to identify the bleeding source. Nephroscopy was recommended after failure of conservative treatments. At operative nephroscopy, done after preliminary cytoscopy to confirm active bleeding, the bleeding sites were identified in all our patients. Discrete submucosal hemangiomas were found in 5 patients and the bleeding could be localized to 1 calix in 7 others. Of our patients 12 underwent partial nephrectomy and 1 had a nephrectomy. To date there has been no recurrence of bleeding in any of these patients. Despite careful histological examination microscopic hemangiomas could be found in only 6 of our specimens. Chronic gross hematuria can be disabling physically and emotionally. In most, if not all, such cases judicious renal exploration with nephroscopy is warranted and cure can be expected with conservative partial nephrectomy.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
10/13. Self-inflicted eye injuries: case presentations and a literature review.OBJECTIVE: The authors' aim was to determine demographic and clinical correlates of self-inflicted eye injury. methods: The authors reviewed 41 cases of patients with self-inflicted eye injuries identified through medlars searches of medical literature for the period from 1980 to 1993 and four cases from the first author's clinical practice. RESULTS: Most patients with self-inflicted eye injuries were male, about 31 years old, and had a diagnosis of schizophrenia, drug or alcohol abuse, depressive disorders, or other psychosis. Some patients experienced cognitive distortions, often involving religious and sexual ideation, and intense fear around the time they injured themselves. Thirty-three percent of the patients with self-inflicted eye injuries also showed other types of self-injurious behavior. CONCLUSIONS: Enucleation of the eye may serve as a defense against witnessing or experiencing a forbidden act. Psychodynamic theories addressing self-mutilation do not explain self-induced eye injury particularly well but may assist the therapist in understanding motivation and in restructuring patients' behavior. Management of these patients requires multidisciplinary, multimodal efforts involving medical specialists, patients, family members, and staff.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
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