1/45. Decreased left ventricular filling pressure 8 months after corrective surgery in a 55-year-old man with tetralogy of fallot: adaptation for increased preload. A 55-year-old man with tetralogy of fallot underwent corrective surgery. Left ventricular filling pressure increased markedly with increased left ventricular volume one month after surgery, then decreased over the next 7 months, presumably due to increased left ventricular compliance. ( info) |
2/45. Anoxic-hypotensive brain injury: neuropsychological performance at 1 month as an indicator of recovery. DESIGN: This case control study included assessments at 3 and 8 weeks post brain injury. Controls were the non-brain injured subjects whose normative data has been published for neuropsychological measures. Data and medical information were obtained with informed consent. OBJECTIVE: This study explored cognitive sequella of anoxic-hypotensive brain injury following cardiac arrest in a 49 year old man with high premorbid function. RESULTS: Improvement was noted at 3 weeks post-injury. By 8 weeks neuropsychological test scores including verbal and visual memory were in the normal range, although they were likely to be lower than premorbid levels. CONCLUSIONS: Relatively good cognitive function within the first month post-anoxia likely indicates improved recovery and benefit from continued rehabilitation. Despite initial presentation, steep recovery curves can be found among survivors of anoxia with eventual return to independent function including driving/child care and return to gainful employment. rehabilitation teams are encouraged to remember that good cognitive function is not predicted by initial Glasgow coma Scores, but may be predicted by return of recall memory during the first month post-anoxic event. Serial cognitive screens can identify individuals with the potential for better recovery. ( info) |
3/45. Evaluation of assay methods for hepatitis b surface (HBsAg) antigen and its antibody (anti-HBs) in viral hepatitis b (VHB)-HBsAg-positive. The sensitivity of methods for the detection of HBsAg and its anti-HBs was compared in serial 1200 sera samples from 30 patients with VHB-HBsAg-positive. HBsAg was tested by gel-diffusion (GD), counter-immunoelectrophoresis (CIE), reversed haemogglutination (rHA), redioimmunoassay (RIA), and enzyme immunoassay (EIA). RIA and EIA methods are statistically significantly more sensitive compared with the other methods (P less than 0.0005). By these methods the minimal concentrations of HBsAg in sera can be proved. Although there is no statistically significant difference in the sensitivity between RIA and EIA, the latter is more sensitive if the subtype ay-HBsAg is considered (12 sera samples). In 24 patients the subtype was ay, in two ad, and in four it could not be differentiated. In 70% of patients anti-HBs was proved by RIA and in 10% by CIE, i.e., in 73% and 9% of sera samples, respectively. In 117 sera samples of these patients the sensitivity of RIA and EIA was compared for determination of anti-HBs. No statistically significant difference between the methods for determination of anti-HBs was found (50.42%: 40.17%). No immune response to HBsAg has been observed in 9 cases, but 6 of them have remained permanent carriers of this antigen. ( info) |
4/45. Effects of reinforcement magnitude on spontaneous recovery. Extinction of operant behavior has been associated with a number of undesirable effects. One such effect is the temporary reappearance of behavior after responding appears to be completely extinguished, known as spontaneous recovery. In this report, the occurrence of spontaneous recovery and its attenuation with large amounts of reinforcement were examined during the treatment of disruption. ( info) |
5/45. The helping process in couples during recovery from heart attack: a single case study. This single case study aimed to illustrate help-intended communication in couples, in particular how a husband and wife attempted to help each other with adjusting to the husband's recent myocardial infarction. The study employed a semi-structured communication task to gather samples of the couple's helping interactions: the couple had two conversations in which they alternated helper and discloser roles. Quantitative and qualitative data were obtained from the couple and from expert raters (observers) about their perspectives of the conversations. The observers' ratings and verbal response mode patterns indicated that the conversations were characterized by low levels of empathy and exploration of feelings and relatively high levels of helper disclosure and advice; overall, the observers found the conversations to be somewhat unhelpful. In contrast, the couple rated the conversations more positively; the 'helpful events' they identified consisted of their partner disclosing a new piece of information and giving advice. The results were discussed in terms of the unique features of helping in close relationships. ( info) |
6/45. A verified case of recovered memories of sexual abuse. A case is presented that shows verifiable evidence of repression at work. Rachel, a 40-year-old woman with no history of mental illness and ten years of exemplary professional work, recovers memories of childhood sexual abuse by her father through a call from her youth pastor in whom she had confided as an adolescent. This reminder triggered a severe depression, suicidal action, and the need for hospitalization. Rachel's older sister, herself an abuse victim, had witnessed the abuse, yet Rachel had no memory of the events. No apparent causes of false memories are present, so a different mechanism than forgetting must have been at work. ( info) |
| Despite the difficulty in diagnosis and the detailed care necessary in both the acute and long-term management of the patient with pulmonary embolism, expertise in this area is requisite for the primary care physician who may expect to encounter this problem with moderate frequency among patients in his clinical practice. ( info) |
8/45. A case of Japanese encephalitis: CT and MRI findings in acute and convalescent stages. We studied the CT and MR images of a patient with Japanese encephalitis. The first symptom was general malaise with high fever. The diagnosis of meningoencephalitis was made by spinal tap and clinical presentation. CT on the third day of illness showed no significant findings. MRI on the fifth day of illness demonstrated that the left thalamus and bilateral putamen were hyperintense on T2-weighted images. On CT one month later, the density in the thalamus and bilateral putamen was normal. MRI two month later showed high signal intensity only in the left thalamus. The patient recovered, but was judged to have dementia according to the simple dementia scale of Hasegawa. Flaccid paralysis was observed during the acute period. ( info) |
9/45. The many faces of Kawasaki syndrome. The clinical challenge lies in recognizing cases not fully meeting the syndrome's diagnostic criteria and those that strongly resemble a variety of infectious and reactive disorders. Prompt treatment with high-dose intravenous immune globulin in combination with aspirin can significantly reduce the frequency and severity of cardiovascular complications. ( info) |
10/45. Re-thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework. Re-thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework The dramatic effects of a stroke can have far-reaching implications for patients and carers. Effective recovery involves a considerable array of coping strategies that facilitate and promote engagement in the social world. Their development is a long-term process that requires considerable effort, motivation and enterprise on the part of patients and their families. Traditional approaches to the provision of stroke rehabilitation services, however, appear to be underpinned by frameworks that are short-term in outlook. As a consequence, nursing interventions often focus on the progression of the patient through the care system, rather than on facilitating future recovery. Much of the work of stroke recovery is consequently done by patients and their families at home, with little provision of ongoing professional help and advice. This paper explores the application of the Corbin and Strauss Chronic Illness Trajectory Framework for stroke. In particular, the major concepts of the framework are applied to a vignette derived from a longitudinal study of patients' experiences of recovery. The trajectory framework is shown to be a useful structure that has the potential to enhance the appropriateness of nursing interventions for stroke patients. However, the validity of the framework can only be established through its application and evaluation in clinical practice. The purpose of this paper is to contribute to a debate that encourages consideration of the framework's utility for nurses to enhance the stroke rehabilitation experience. ( info) |