Impact of a family-centred approach on a couple living with a brain tumour: a case study

The diagnosis of a malignant brain tumour can be devastating for both patients and their families. Despite neurological and cancer treatment advances, there has been little progress in extending life expectancy for these patients. Cassileth et al. (1985) suggest that of all types of cancer, brain tumours cause the most psychosocial repercussions for the family. The brain tumour clinical nurse specialist (CNS) is in a strategic position to intervene with families along the continuum of care by using a family-oriented approach which can facilitate their adaptation to this health problem. The present case study will describe the illness experience of one couple where a member had a brain tumour. The process of assessment, interventions and outcomes will be highlighted. The CNS utilized the Calgary Family Assessment Model (CFAM) (Wright & Leahey, 1984) and Calgary Family Intervention Model (CFIM) (Wright & Leahey, 1994) to guide her work with this family. An example of an intervention was the illness narrative approach. In this approach the concepts of illness experience, perceptions, beliefs and support were used as part of the therapeutic modality which served to enhance the coping strategies of the couple and decreased their crisis situation. This collaborative style of nursing promoted the well-being throughout the illness trajectory of both the family and the CNS.     

Hemiballism as a presentation of a meningioma

A 73-year-old woman with a meningioma presented with hemiballism. This is the report of an unusual presentation of a primary brain tumor.     

Melatonin: a clock-output,a clock-input

In mammals, the circadian system is comprised of three major components: the lateral eyes, the hypothalamic suprachiasmatic nucleus (SCN) and the pineal gland. The SCN harbours the endogenous oscillator that is entrained every day to the ambient lighting conditions via retinal input. Among the many circadian rhythms in the body that are driven by SCN output, the synthesis of melatonin in the pineal gland functions as a hormonal message encoding for the duration of darkness. Dissemination of this circadian information relies on the activation of melatonin receptors, which are most prominently expressed in the SCN, and the hypophyseal pars tuberalis (PT), but also in many other tissues. A deficiency in melatonin, or a lack in melatonin receptors should therefore have effects on circadian biology. However, our investigations of mice that are melatonin-proficient with mice that do not make melatonin, or alternatively cannot interpret the melatonin message, revealed that melatonin has only minor effects on signal transduction processes within the SCN and sets, at most, the gain for clock error signals mediated via the retino-hypothalamic tract. Melatonin deficiency has no effect on the rhythm generation, or on the maintenance of the oscillation. By contrast, melatonin is essential for rhythmic signalling in the PT. Here, melatonin acts in concert with adenosine to elicit rhythms in clock gene expression. By sensitizing adenylyl cyclase, melatonin opens a temporally-restricted gate and thus lowers the threshold for adenosine to induce cAMP-sensitive genes. This interaction, which determines a temporally precise regulation of gene expression, and by endocrine-endocrine interactions possibly also pituitary output, may reflect a general mechanism by which the master clock in the brain synchronizes clock cells in peripheral tissues that require unique phasing of output signals.     

Urethral extrusion of a peritoneal catheter in a patient with a neobladder: a rare complication of shunt insertion

The insertion of a ventriculoperitoneal shunt (VPS) is considered the standard of care for several forms of hydrocephalus. Abdominal complications are most common with this procedure, comprising up to 30% of all shunt-related problems. Conversely, visceral perforation or extrusion of the shunt apparatus is rare. Herein we report a rare complication of VPS insertion in which the peritoneal catheter was spontaneously extruded through the urethra of a patient with a neobladder. We further discuss the pathogenesis, diagnosis, and treatment of this condition.     

Brain embolization of a healthy artery fragment as a complication of a cardiac catheterization

Ischemic stroke is the most common neurological complication of cardiac catheterization resulting in a high morbidity and mortality. We present a 44-year-old man admitted for vasospastic angina that suffered a right middle cerebral artery (MCA) occlusion after a cardiac catheterization. Mechanical thrombectomy was indicated and complete arterial recanalization was achieved. The material obtained showed a fragment of a healthy artery. Partial radial endarterectomy and cerebral embolization may be a rare complication of cardiac catheterization.     

Intraparenchymal Pericatheter Cyst as a Complication of a Ventriculo-Peritoneal Shunt in a Premature Infant

A ventriculo-peritoneal shunt is a standard surgical management for hydrocephalus, but complications may impede the management of this disease. Obstruction of the catheter is one of the most common complications and manifests clinically in various ways. Intraparenchymal cyst development after shunt malfunction has been reported by several authors, but the underlying mechanism and optimal treatment methods are debatable. The authors report a case of intraparenchymal cyst formation around a proximal catheter in a premature infant after a ventriculo-peritoneal shunt and discuss its pathogenesis and management.     

Between a psychiatric diagnosis and a familial diagnosis

If the idea of a biopsychosocial model is not going to be merely a phrase, then every clinical diagnosis and therapeutic vision need to consider the familial issues. Taking the family issues into consideration has evident gains; it allows for a better understanding of the patient and allows for actions which reduce the risk of a relapse of illness. The fact that such issues are not part of the therapeutic armament, despite the effectiveness of psychoeducation, is bewildering: on one hand the families are not always invited to co-operate, on the other hand--they often give up this co-operation. In such a situation, the relation between the patient's family and the personnel needs analysis, especially common, often unconscious emotions and prejudices. They can form a dysfunctional 'knot', which does not allow for a therapeutic alliance to be formed. How to come out from such an impasse and make a common positive alliance? Paradoxically, the therapeutic possibilities are bigger when--especially in the initial phase of treatment--the psychiatrist "is able to not know" and is capable of listening into the patient's family perspective, and has an interest in the 'family story'. It is only after the knowledge on the family is gained and the family perspective is accepted, that the deconstruction of that part of the family's story that forms the problem and a common search for "positive changes" are possible. Although it may not appear to be so, such an ordeal can be very difficult for the psychiatrist who is used to controlling the situation through psychiatric theory and diagnosis, psychiatric language and the psychiatric institution. The issue presented appears to be part of a universal dilemma: what is the range of "the language power" of the psychiatrist and when is the sharing of this power with the patient and the family beneficial for the therapy.     

Interfacing a modern signal averager to a minicomputer

The design and operation of a bidirectional interface for transfer of data between a signal averager (Nicolet 1170) and a minicomputer (PDP-11/34) are described. The interface has been shown to function reliably using data lines of 20 m.     

Radiological Follow-up of a Cerebral Tuberculoma with a Paradoxical Response Mimicking a Brain Tumor

We report a case of a paradoxical response of a tuberculoma in the brain mimicking a brain tumor. A 76-year-old woman presented with a 2 week history of headache, dysarthia, and orthopnea. Brain magnetic resonance images (MRI) revealed two rim-enhancing lesions on the pons and occipital lobe, and chest computed tomography showed randomly distributed miliary nodules. The tentative diagnosis was tuberculosis (TB) of the brain and lung. She complained of right hemiparesis and worsening general weakness after taking the anti-TB medication. On the monthly follow-up images, the enhanced lesions were enlarged with increased perfusion and choline/creatinine ratio, suggesting a high grade glioma. A surgical resection was completed to diagnose the occipital lesion, and the tuberculoma was pathologically confirmed by a positive TB-polymerase chain reaction. The anti-TB medication was continued for 13 months. A follow-up MRI showed decreased size of the brain lesions associated with perilesional edema, and the clinical symptoms had improved. Brain tuberculoma could be aggravated mimicking brain malignancy during administration of anti-TB medication. This paradoxical response can be effectively managed by continuing the anti-TB drugs.     

When a schizophrenic deficit becomes a reasoning advantage

A deficit in context processing has been proposed to be one of the major deficiencies in schizophrenia. A demanding reasoning task, known to promote a very reproducible bias (i.e., a reasoning error) in healthy subjects, triggered by a misleading context, was administered in 26 schizophrenic patients and 26 healthy participants. Responses at random were checked by including an additional group of 11 schizophrenic patients who performed a control version of the task. We showed that patients presented a surprising imperviousness to the reasoning bias and had significantly better logical performances than their paired healthy participants. This finding demonstrates that there are some problem solving situations where disregarding contextual information, a cognitive deficit that usually impairs schizophrenic patients gives them a cognitive advantage over healthy controls.     

Protein Z, a protein seeking a pathology

Protein Z (PZ) is a vitamin K-dependent factor identified in human plasma in 1984 characterized by an homology with other vitamin K-dependent factors (factor VII, IX, X, protein C). In contrast to these factors, PZ does not possess any enzymatic activity but is involved as a cofactor in the down-regulation of coagulation by forming a complex with the protein Z-dependent protease inhibitor (ZPI). ZPI inhibits the activated factor X (FXa) on phospholipid surface. In mice, the disruption of PZ gene is asymptomatic, but the association with the factor V Leiden mutation leads to a quasi complete mortality during the neonatal period with microvascular thrombosis. In humans, PZ is characterized by an unusual wide distribution in plasma, and a major decrease induced by warfarin. Isolated PZ deficiency does not seem to constitute a risk for venous thrombosis, but a severe PZ deficiency could increase the risk of well recognized venous thrombotic risk factors such as factor V Leiden, G20210A mutation or hyperhomocysteinemia. Unexpectedly, a relationship between PZ deficiency and ischemic arterial diseases such as stroke, acute coronary syndromes or peripheral arterial disease was described but not confirmed by all studies. PZ deficiency could be also a risk factor for early fetal losses, and increases the arterial risk in antiphospholipid syndrome. This review analyzes the different studies so far published and discusses the various results obtained in order to understand whether or not protein Z deficiency could be considered as an arterial ischemic risk factor.     

Psychodynamics of a prostitute: a case report

The topic of prostitution has been examined from many viewpoints, but psychodynamic contributions have been limited. The authors present material from a psychoanalytic psychotherapy with a prostitute. The intrapsychic determinants of the patient's choice to become a prostitute are discussed. The prostitution appeared to offer numerous hidden gratifications for this patient, including fulfillment of passive sexual wishes and opportunity to experience closeness with men without fear of abandonment or betrayal.     

Use of a computer-based application in a pediatric hemodialysis unit: a pilot study

This report describes preliminary efforts to implement a computer-based application, called Zora, in a pediatric hemodialysis unit. The feasibility and safety of establishing a virtual community in the hemodialysis unit are explored. Zora allows users to design and inhabit a graphical virtual city where they create characters, stories and spaces while communicating in real-time. Over a 5-month period, 7 hemodialysis patients and 4 unit staff found Zora enjoyable and safe. The results support the premise that computational environments may offer an opportunity for pediatric patients and their caregivers to participate in virtual communities that promote coping with chronic physical illnesses.     

Diagnostic agreement between a doctor and a nurse for psychiatric disorders: a pilot study

The objective of the study was to examine inter-rater agreement for psychiatric disorders by means of a structured interview performed by a psychiatrist and a nurse. Sixteen psychiatric inpatients with a mean age of 38.9+/-12.9 years were assessed independently by a psychiatrist and a nurse using a structured psychiatric interview, Strukturert Psykiatrisk Intervju for Allmennpraksis (SPIFA). For most diagnoses, agreement was substantial to perfect (kappa = 1 for the diagnoses major depression, generalized anxiety disorder, obsessive-compulsive disorder and substance abuse). Fair to moderate kappa values were found for personality disturbances and dysthymia. The results of this study indicate that after adequate training nurses can perform structured psychiatric interviews with a high inter-rater agreement.     

Antiepileptic drugs: a case report in a pregnancy with a neural tube defect

While receiving lamotrigine, a patient pregnant with triplets suffered a double fetal neural tube defect. Plasma homocysteine, folate, vitamins B12 and B6 (pyridoxal phosphate), and red cell folate levels were measured in samples while she was receiving folic acid therapy for 1 month during the second trimester of pregnancy. Some mutations were sought, involved in homocysteine metabolism and linked with the folate metabolism. Her results were compared with those of a pregnant woman with normal triplets and with those of 58 pregnant women, with a normal pregnancy. Results indicated a decrease in vitamin B12 and B6 values in plasma in the patient, and a genotype AG (polymorphism A66G) was observed, but was not found in the pregnant woman with normal triplets. Even if lamotrigine therapy is not known to be associated with significant changes in red cells or in serum folate, periconceptional folic acid supplementation is counseled for women, along with periconceptional B12 and B6 vitamin supplementation when their plasma values are decreased.     

Cerebroretinal vasculopathy mimicking a brain tumor: a case of a rare hereditary syndrome.

We report a 35-year-old man with hereditary cerebroretinal vasculopathy (CRV) characterized by retinal microvascular changes and a right frontal intracerebral mass lesion that suggested a brain tumor. Histopathologic analysis of the patient's brain lesion as well as reviewed specimens of the patient's mother, who had reportedly died of a brain tumor, showed no neoplasia but did show cerebral microvasculopathy. CRV should be considered as a differential diagnosis for patients with intracerebral mass lesions, retinal vascular changes, and a positive family history of "brain tumors."     

Recurrence in a different location of a cerebral arteriovenous malformation in a child after radiosurgery

The case of a 9-year-old girl with a right parietal arteriovenous malformation (AVM) of the brain obliterated after gamma knife (GK) radiosurgery with subsequent regrowth in a different site is reported. As far as we know, this is the first reported case of regrowth of an AVM in a different location after radiosurgery in a child. This situation has to be considered within the context of causes of unsuccessful treatment of AVMs with radiosurgery and justifies angiographic monitoring of pediatric patients until they reach adulthood. Received: 27 October 1999     

Mobilization of a nursing community after a disaster

TOPIC: This article is a personal account of the author's experience of coordinating American Red Cross Disaster Health Services in her home community (Fort Worth, TX) following Hurricane Katrina. Although the community was 550 miles away from the impacted area, thousands of evacuees arrived in this community in need of immediate attention. PURPOSE: The purpose of this article is to share significant lessons that were learned from the experience to help other communities prepare for future disasters. SOURCE FOR INFORMATION: The article is derived from the author's experience and observation. CONCLUSIONS: In the midst of a disaster, nurses have a unique opportunity to make a professional contribution to recovery efforts. Learning from previous experiences can strengthen the effectiveness of our response.     

Axon-glia transfer of a protein and a carbohydrate

We have investigated the transfer of a fluorescent protein, the fluorescein isothiocyanate derivative of bovine serum albumin (FITC-BSA), and a fluorescent carbohydrate, FITC-dextran, from the crayfish medial giant axon (MGA) to the periaxonal glial cells. The dialyzed tracer was injected into one of the two MGAs, and, after a transfer period of 15-60 min, the tissue was fixed for histological examination of fluorescence distribution. With each tracer, the periaxonal sheath of the injected MGA was specifically labeled. Similar results were obtained with several different fixatives. During the transfer period, there was no appreciable change in the resting potential or conducted action potential of the MGA or in the resting potentials of the adaxonal glial cells. Polyacrylamide gel electrophoresis indicated that the axoplasmic and sheath fluorescence was produced by the intact tracers. These results suggest that "foreign" macromolecules can be exchanged from crayfish axons to glia under physiological conditions. Such transfers may indicate a substantial intercellular traffic of molecules or a means whereby neurons can eliminate waste materials.     

Acute psychosis in a woman with a prolactinoma

Changes in dopaminergic activity were inferred in a woman with a known prolactinoma several months prior to an acute psychotic episode. Serum prolactin levels reflected central dopaminergic activity, since both the endocrinologic regulation of prolactinomas and the pathophysiology of acute psychosis have been linked to alterations in dopaminergic activity. Serum prolactin levels fell approximately four months prior to onset of the psychotic episode and thus may have provided a predictive indicator of changing dopamine activity in both the tubero-infundibular and the mesolimbic-mesocortical dopaminergic systems.