1/20. A staff dialogue on a socially distanced patient: psychosocial issues faced by patients, their families, and caregivers.Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The following case of an hiv-positive woman who was diagnosed with cervical cancer during a twin pregnancy was discussed at the May, 1999 Schwartz Center Rounds. The patient was in drug rehabilitation having been dependent on crack cocaine, with a past history of syphilis and gonorrhea. She was single and her other children were in foster care. Initially she was suspicious and non-compliant. A plan was negotiated to biopsy the cervical lesion after cesarean section and with confirmation of malignancy she underwent radical surgery and subsequently radiotherapy. Despite the almost insurmountable social and educational distance between her and her caregivers, they managed to bond and facilitate care. Although there were compromises with which staff were uncomfortable, the relationship was maintained and continues.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
2/20. Working and "drugging" in the city: economics and substance use in a sample of working addicts.employment status is often treated as a "risk factor" in epidemiologic studies of drug use. The process that underlies the supposed relationship has remained, however, essentially unexamined. This article uses life history data to look at the relationship between work and drug use in a sample of addicts from baltimore City, maryland. The narratives constructed by these individuals demonstrate that the processes involved in creating and maintaining drug- and nondrug-related identities are neither linear nor straightforward. Rather, managing complex, emergent identities is a product of the economic situation, the organization of the drug scene, and the larger milieu in which these addicts operate.- - - - - - - - - - ranking = 0.02874785860354keywords = individual (Clic here for more details about this article) |
3/20. Substance abuse and emergency psychiatry.Given the high rates of comorbidity, patients commonly present with multiple diagnoses to PESs or crisis services. Clinicians must be well versed in the evaluation, differential diagnosis, and treatment of patients with substance-abuse disorders or other axis I, II, or III conditions if they are to provide state-of-the-art treatment of patients in need of emergency care.- - - - - - - - - - ranking = 1.6992795056433keywords = service (Clic here for more details about this article) |
4/20. Catastrophic medical complication in psychogenic excoriation.Compulsive skin picking generally has limited potential health consequences. We describe a case with severe neurologic sequelae and review the literature to assess factors that likely contributed to the failure to prevent this severe outcome. Despite efforts to integrate treatment, our patient had severe medical complications, an epidural abscess and subsequent paralysis, as a result of compulsive skin picking. Psychogenic excoriation should not be underestimated as a cause of medical complications or as a treatment challenge, particularly in light of the numerous complicating factors often present in such cases.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
5/20. Hepatorenal problems presented in an urban high dependancy unit in a user of ecstasy and cocaine.A case is presented of a young man aged 25 years who had an episode of jaundice and renal failure after using a small amount of ecstasy and cocaine. There is a discussion of the issues raised by the case as well as some points of interest for research and health education.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
6/20. The surgical abdomen associated with cocaine abuse.Cocaine use is common and is associated with gastrointestinal complications that can present as a surgical abdomen. We report a case of a previously healthy 25-year-old man who presented to the Emergency Department with severe abdominal pain and vomiting after using IV cocaine. Exploratory celiotomy revealed massive free intraperitoneal (IP) clotted blood with no evidence of underlying pathology. This unusual case underscores the possibility of life-threatening hemorrhage in cocaine consumers.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
7/20. Fatal case of delayed repolarization due to cocaine abuse and global ischemia.When a previously healthy, middle-aged patient presents with apparent seizures, what should alert the physician to the possibility of underlying cardiac disease? This report describes a case of long qt syndrome, initially presenting as seizures, which expressed itself at an atypically advanced age as a result of cocaine use, global myocardial ischemia, and ventricular tachycardia.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
8/20. Drug addiction in sickle cell disease: case report.There has been widespread speculation that patients with sickle cell disease (SCD) may become drug dependent if their painful crisis is treated with narcotics. However, there has been no scientific evidence to support this assertion. Paradoxically, individuals suffering from sickle cell disease who are not adequately treated may develop an addiction to narcotics due to self-medication to treat their pain. In this article, we describe a 38-year-old African American woman who became addicted to cocaine due to self-medication of her sickle cell pain with cocaine.- - - - - - - - - - ranking = 0.02874785860354keywords = individual (Clic here for more details about this article) |
9/20. Thoracic aortic dissection associated with cocaine abuse.Cardiovascular complications of cocaine abuse include myocardial ischemia and infarction, dysrhythmias, cardiomyopathies and aortic dissection. The case in point pertains to a 26-year-old, Caucasian male, substance abuser who suffered a thoracic aortic dissection following the use of crack cocaine. The autopsy and histological findings showed a connective tissue abnormality including a focal microcystic medial necrosis and a fragmentation of the elastic fibers in the arterial walls. blood concentrations of cocaine and benzoylecgonine, taken individually, were considered to be within a potentially toxic range. blood concentrations of methadone also indicated use of this drug at the same time. The small amounts of morphine found in the blood and urine were compatible with heroine or morphine use more than 24 h before death.- - - - - - - - - - ranking = 0.02874785860354keywords = individual (Clic here for more details about this article) |
10/20. Dental erosion: a complication of pervasive developmental disorder.A young teenage male presenting for a routine check-up reported no health problems. Initial clinical examination revealed some enamel loss on the palatal surfaces of the maxillary incisors. Erosion lesions were suspected. Similar lesions, however, were not found throughout the mixed dentition and radiographic findings were inconclusive. To confirm the diagnosis of these lesions and, more importantly, to disclose the etiology, a thorough and detailed clinical examination of these lesions was conducted. Study models were made, mounted in centric occluding position, and closely screened. In addition, the health history was revisited, by interviewing the patient and his legal guardian. The information gathered led to the conclusion that the lesions in question were erosion lesions with concomitant wear facets that resulted from attrition of the softened enamel surface. An ample light on the possible etiological factors was shed, which assisted in the planning phase for the course of management. It is not uncommon that dental health care providers encounter in daily practice cases of early erosion lesions similar to those reported here. In most of these instances, minor changes in tooth morphology that represent a slight departure from the norm could be overlooked and often ignored. If such lesions go undetected, the underlying causes may escape diagnosis. However, if action is taken to pursue investigation of the causative factor, the result could assist in understanding the overall complexity of the health condition of the patient. This would enable planning the proper course of management for the total well being of the patient.- - - - - - - - - - ranking = 4keywords = health (Clic here for more details about this article) |
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