1/38. Psychiatric consultation for physically ill children. In addition to age-appropriate information about his physical condition and its treatment, the child needs help with the feelings associated with being ill or injured. If the feelings are so powerful that a state of despair exists, or are strongly defended against with self-defeating and unresponsive behavior, consultation with the child psychiatrist should be requested. ( info) |
2/38. Kartagener's syndrome with corrected transposition. Conducting system studies and coronary arterial occlusion complicating valvular replacement. An 18-year-old man whose sister has classic Kartagener's syndrome was found to have sinusitis, bronchiectasis, and corrected transposition with normal visceral situs. Congenital complete heart block was secondary to absence of conducting-system pathways between a small posterior atrioventricular node and the transposed His bundle and bundle branches. No anterior atrioventricular node was present. Prosthetic valvular replacement of the left-sided (morphologic right) atrioventricular valve was complicated by coronary arterial occlusion by suture, with subsequent myocardial infarction. The case appears to represent an unusual variant of Kartagener's syndrome with the abnormality of laterality being expressed as corrected transposition. ( info) |
3/38. Use of calcitonin for the treatment of an odontoid fracture. Case report. The authors report on the efficacy of nonsurgical treatment of an older patient with a fractured odontoid process. The patient, an 85-year-old woman, had multiple medical problems that put her at an increased surgery-related risk. Therefore, an alternative approach was elected, including immobilization with a philadelphia collar and the provision of calcitonin nasal spray. Bone union and clinical recovery were achieved within 8 weeks of initiating the nasal calcitonin therapy (12 weeks postinjury). Considering the patient's age, comorbidities, and the severity of the fracture, the recovery period was unusually short. The authors believe that calcitonin played a pivotal role in the healing process of the fractured odontoid bone. There is no question that the fusion in this patient could be unrelated to the medical therapy. This description of one patient, as well as the lack of a large randomized study, precludes any scientific conclusions. Nevertheless, the authors believe that the development of a successful fusion in this high-risk patient should be reported as an observation that merits confirmation and study. The authors also discuss the physiological effects of calcitonin and the research and clinical experience with this hormone in different conditions affecting bone. ( info) |
4/38. causality in medicine: towards a theory and terminology. One of the cornerstones of modern medicine is the search for what causes diseases to develop. A conception of multifactorial disease causes has emerged over the years. Theories of disease causation, however, have not quite been developed in accordance with this view. It is the purpose of this paper to provide a fundamental explication of aspects of causation relevant for discussing causes of disease. The first part of the analysis will discuss discrimination between singular and general causality. Singular causality, as in the specific patient, is a relation between a concrete sequence of causally linked events. General causation, e.g. as in disease etiology, means various categories of causal relations between event types. The paper introduces the concept of a reference case serving as a source for causal inference, reaching beyond the concept of general causality. The second part of the analysis provides exemplification of a theory of causation suitable for discussing singular causation. The chain of events that induce a disease state can be identified as effective causal complexes, each complex composed of non-redundant components, which separately contribute to the effect of the complex, without the individual component being necessary or sufficient in itself to produce the effect. In the third part of the analysis the theory is elaborated further. Causes, defined as non-redundant components, can furthermore be differentiated according to their avoidability, according to theories about human error or by the potential of eradication. Multifactorial models of disease creates a need for systematic approaches to causal factors. The paper proposes a taxonomical terminology that serves this purpose. ( info) |
5/38. Prematurity and adult minor illness. The long term impact of being born premature has received limited scientific investigation. Studies that have been carried out, focus on outcomes in childhood, with very few considering the impact on adult physical health. Three case studies are presented here, investigating differences in adult minor illness and psychological variables between adult participants born preterm, fullterm but small and fullterm with normal birthweight. This is a retrospective design using questionnaires and checklist to gather relevant information. Minor illness symptoms, daily hassles, anxiety, depression and general self-efficacy were measured. The participant born preterm scored higher on all measures. Data were applied to the Equilibrium Model for Minor Illness. Being born early appears to have a greater impact on later adult outcomes measured than being born fullterm but small or fullterm but of normal weight. In this article the authors reflect upon possible explanations for the different outcomes of each of the participants within the foetal origins of disease theory. ( info) |
6/38. A Canadian medical-psychiatric inpatient service. Patients with both psychiatric and medical illnesses present complex and, at times, difficult diagnostic and management problems. Medical-psychiatric units designed to provide integrated medical and psychiatric care have been established in the united states. This paper describes the development and structure of such a unit established at a Canadian general hospital, using psychiatric facilities and resources already in place. A one year review of the characteristics of patients discharged from the service found that their mean length of stay was similar to that of inpatients discharged from the general adult inpatient services, but shorter than that of patients discharged from the psychogeriatric service. Many of these patients had neurological conditions; coexisting affective disorders, substance abuse, organic mental syndromes and somatoform disorders were diagnosed frequently. We believe that a medical-psychiatric inpatient unit can provide integrated care to patients who might otherwise receive less than adequate care. ( info) |
7/38. altitude medicine and physiology including heat and cold: a review. With increasing numbers of people travelling to high altitude destinations for recreation or work, there is a need for practitioners of travel medicine to be familiar with altitude illnesses and the physiology of altitude. In mountainous areas travellers may also be exposed to problems of heat and cold. This article reviews these topics and gives practical advice on the management of the clinical problems involved, together with a discussion of underlying mechanisms, as far as they are understood at present. ( info) |
8/38. Maladaptive denial of physical illness: a proposal for DSM-IV. Denial of physical illness is a commonly encountered problem in consultation-liaison psychiatry. Although there is an extensive literature on denial, it has virtually ignored the diagnostic issues raised by the individual whose denial of physical illness is clearly maladaptive. The authors propose that DSM-IV include a subtype of adjustment disorder called "with maladaptive denial of physical disorder." They discuss this new category, its differential diagnosis, and the benefits to clinical practice of this proposed addition to diagnostic classification. ( info) |
9/38. Medical conditions of importance in dental practice. Good dental practice requires that a dental practitioner be aware of those medical conditions that might present first with oral manifestations and those for which special considerations are required before dental treatment is rendered. In view of the rapid changes in the understanding and treatment of disease, it is essential that a dentist be current in his knowledge of medicine and be aware of the established and accepted methods of patient management. ( info) |
10/38. depression and medical illness. depression is the most common psychiatric complication of severe medical illness, and it occurs in about 20% of cases. diagnosis of depression in patients with serious medical illness requires modified criteria. Treatment also must be adjusted for patients with such dual diagnoses. ( info) |