1/5. Silence as resistance to medical intervention.A group of 47 individuals initially silent about their physical symptoms and/or dysfunction were studied after they finally had come to medical attention. They were then interviewed, using the associative anamnesis technique, to evaluate the psychologic aspects of their silence. It was found to be a key element in the defensive complex directed against intense neurotic feelings activated by the patient's current physical condition. The tendency toward silence appeared to have been reinforced by emotionally traumatic experiences involving physical illness or injuries in early life. Also found associated with silence were such different factors as a series of ostrich-like denying rationalizations, a fanatic commitment to cultist beliefs, a conviction that emotional conflict is the primary cause of organic illness, and motivations linked to retention of power in reality situations. Clinical examples drawn from these categories are given. Means of increasing the awareness that such silence exists and methods of dealing with it are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Occult duodenal perforation complicating cerebral infarction: new problems in diagnosis of Cushing's ulcer.Cushing's ulcers of the duodenum are well known complications of neurosurgery, head trauma, and other causes of increased intracranial pressure. Perforation of Cushing's ulcer of the duodenum is infrequently described. That the use of high-dose corticosteroids for cerebrovascular infarct in an aphasic patient may obscure the symptomatology and physical findings of a perforated Cushing's ulcer has not been described to our knowledge. We report a patient with a large left hemispherical infarct and resultant aphasia who developed a perforated duodenal ulcer and extensive chemical peritonitis while receiving high dose corticosteroids for increased intracranial pressure. She was unable to register any complaints and the typical physical findings of perforated duodenal ulcer with chemical peritonitis were virtually absent. A high index of suspicion must be maintained for a perforated Cushing's duodenal ulcer in the patient receiving high dose dexamethasone despite the presence of nonspecific symptomatology and abdominal findings. Elevated serum gastrin levels, as in this patient, may also indicate the patients with increased intracranial pressure who are at greater risk for developing Cushing's ulcer.- - - - - - - - - - ranking = 0.66666666666667keywords = physical (Clic here for more details about this article) |
3/5. Perforated peptic ulcer in the elderly.From 1973 through 1979, 32 patients over 60 years of age were admitted to the Beth israel Medical Center, new york, because of a perforated gastric or duodenal ulcer. In many of them, the symptoms and physical findings were minimal. In abdominal roentgenograms (subject erect or supine), only 17 (60 percent) of these patients showed free intraperitoneal air. Among the 29 surgically treated patients, plication of the ulcer was performed in 28 and hemigastrectomy-vagotomy in one. The postoperative morbidity rate was 62 percent, and the mortality rate 17 percent. In 3 of the 32 patients, the diagnosis of perforated ulcer was established only at autopsy. Thus, failure to diagnose this condition accurately may be the principal cause of death in elderly patients with a perforated peptic ulcer. The increased use is recommended of contrast roentgenograms of the stomach and duodenum and of endoscopy, in an effort to improve diagnostic accuracy in dealing with perforated peptic ulcers.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
4/5. multiple myeloma and gastric carcinoma. Possible late effects of limited abdominal X-irradiation.A man, aged 34, was treated in 1954 for duodenal ulcer by antroduodenectomy followed by X-irradiation to the stomach in a dose of 2,000 rads. Over two decades, he developed several conditions attributable to the previous irradiation, including the physical appearances of premature ageing, shrinkage of the left kidney due to irradiation nephritis, immune deficiency, multiple myeloma of IgA type, and lastly, carcinoma of the stomach. The kidneys, especially the left, the bone marrow and stomach would have been in the field of X-irradiation. These effects of local X-irradiation are discussed in relation to the known effects of total body irradiation in causing decreased longevity in animals and inducing cancer in man.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
5/5. From emergency room to morgue: deaths due to undiagnosed perforated peptic ulcers. Report of four cases with review of the literature.peptic ulcer perforation is well recognized as a cause of peritonitis and can result in death. Although amenable to surgery, delay in making the correct diagnosis results in increased mortality. Accurate diagnosis has been hindered by demographic changes in the affected population. In recent years, the population at risk has increased. Specifically, a rising incidence has been observed in women, in the elderly, and in patients with previously undiagnosed peptic ulcer disease. Described are four patients with perforated peptic ulcers, three of which were not detected prior to autopsy. In three of the four instances the patient had been observed in and discharged from a hospital emergency room during the 30 h prior to death. In the fourth case, the decedent had been seen in and discharged from the emergency room four times during the month prior to death. In all patients, the presenting historical, physical, and/or radiographic findings were indicative of perforation. The death of a patient within days of a visit to an emergency room should prompt a forensic autopsy. The role of medical examiners in providing quality assurance feedback to emergency rooms located within their jurisdiction is emphasized.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |