A case of Capgras delusion following critical illness

Hallucinations and paranoid delusions are recognised complications of critical illness. However, the occurrence of Capgras syndrome, in response to critical illness, where patients are convinced that doubles have replaced close family has not been described in the literature. There have been isolated case histories in the literature in response to medical procedures or illness but mostly in patients suffering from schizophrenia. A 42 year old woman was admitted to the intensive care unit (ICU) with pneumonia, following extensive surgery for a squamous cell carcinoma, secondary to Crohns disease. She had no history of previous head injury, cerebro-vascular problems or psychiatric disorder. She reported having memories of all her family, with the exception of her mother, being replaced by aliens while she was on the ICU. The delusion was only diagnosed once it had resolved and the patient was able to talk, and this highlights the difficulty of diagnosing delusions while patients are still intubated and unable to verbalise their concerns. It has been suggested that a defect in the ability to recognise the emotional significance of the face lies at the root of Capgras syndrome. Received: 16 December 1998/Final revision received: 25 June 1999/Accepted: 6 July 1999     

Regional head and face pain relief following lower cervical intramuscular anesthetic injection

BACKGROUND: Although cervical trigger point intramuscular injections are commonly used to relieve localized neck pain, regional head pain relief from lower cervical paravertebral injections has not been reported previously. PURPOSE: To evaluate the safety and efficacy of such injections in a selected group of patients with intractable head or face pain. METHODS: In a series of patients with chronic head or face pain, local anesthetic was injected into the lower cervical spine paravertebral musculature approximately 1 to 2 inches lateral to the seventh cervical spinous process. RESULTS: In addition to producing rapid relief of palpable scalp or facial tenderness (mechanical hyperalgesia and allodynia pain), this lower cervical intramuscular injection technique alleviated associated symptoms of nausea, photophobia, and phonophobia in patients with migrainous headache. CONCLUSION: Our results suggest that lower cervical intramuscular anesthetic injection may be an effective treatment for head or face pain.     

Plastic baton round injuries

Objectives: To review the injuries resulting from a new plastic baton round.

Methods: Review of case notes of patients presenting with injuries caused by plastic baton rounds over a four month period in Northern Ireland.

Results: Twenty nine patients were identified, 28 with 30 injuries were included in the study. Eighty nine per cent were male; the average age was 24.3 years. Seven patients required admission. There were no fatalities. Five injuries were to the upper limbs and 16 to the lower limbs. Three patients sustained pulmonary contusions. There were no head injuries.

Conclusions: Although the numbers in this study are small it should be noted that no patient suffered a face, neck, or head injury. This is in contrast with previous studies in which up to 41.4% of attendances were for face, neck, or head injuries. In this study there were seven injuries to the trunk. Of the 14 deaths attributable to plastic baton rounds in Northern Ireland, all have been the result of head or chest trauma. The use of plastic baton rounds has decreased and, while a reduction in head injuries is noted, potentially serious chest injuries are still occurring. It is vital that guidelines on firing are adhered to. A large proportion of people who have been struck by plastic baton rounds do not attend an accident and emergency department and therefore doctors must be aware of patients with potentially serious injuries presenting late.

     

Perceptions of training for care attendants employed in the care of older people

BACKGROUND: Care attendants, have long assisted nurses in the provision of care for older people in a variety of care settings in Ireland. While there has been recent interest in the provision of formal training for this grade of health care worker the majority remain untrained and unregulated. AIM: This paper describes a study undertaken to explore the perceptions of nurses and care attendants regarding the provision of formal training for care attendants employed in the care of the older people in southern Ireland. The aim was to identify through empirical research, the perceived implications of this training on the role of both nurses and care attendants. RESEARCH METHODOLOGY: A qualitative research design was used to afford each set of respondents the opportunity to express their thoughts and concerns. The research sites were two settings providing long-term care for older people. The research sample nurses (n = 40) and care attendants (n = 40). Data was derived through the use of two research instruments, focus group discussion and a questionnaire containing open-ended questions. Themes were extracted from the data using content analysis. RESULTS: The study identifies positive attitudes towards training for care attendants by both nurses and care attendants but also a perceived link between the provision of training and a blurring of role boundaries. In addition, findings disclose that although nurses are positively disposed to the training of care attendants, this is not accompanied by a desire to become actively involved. CONCLUSIONS: The study indicates a positive view of training for care attendants, also highlighting the importance of role clarification. Results are particularly relevant in the present climate of demographic change, changes in nurse education and staff shortages in Ireland.     

Measuring feeding difficulty in patients with dementia: developing a scale

Feeding difficulty in elderly people with dementia is well documented and the need for research in this area of nursing care has been raised by several authors. One hundred and twelve elderly people with dementia were entered into a study of feeding difficulty. Data were gathered by means of a questionnaire administered to the nurses caring for the patients. The aspects of feehg difficulty which were investigated were based on reports of relevant behaviour in the literature and included refusal to eat, turning the head away, refusing to open the mouth, spitting, allowing food to drop out of the mouth and not swallowing. It was possible to arrange these different aspects of feeding difficulty under three headings: (a) refusal to eat, (b) spitting, and (c) inability to swallow, and to analyse the pattern of accumulation of these feeding difficulties by means of Guttman scale analysis. According to this analysis, the feeding Uculties investigated form a cumulative and unidimensional pattern. The implications of this pattern and the possibilities for further research are discussed.     

Defence mechanisms and some notes on their relevance for the caring professions

Freud's concept of defence mechanisms means a perceptual, emotional or cognitive distortion of the inner or outer reality. The opposite of defence mechanisms is coping mechanisms. The adaptiveness/maladaptiveness of defences are disputed. Various fields of research have given evidence to their maladaptiveness as ways of dealing with threatening stimuli. It has been found that defences can lead to insensitivity to danger signals, lowered coping capacity to life stresses with increased vulnerability to "psychosomatic diseases", delay in seeking help for somatic symptoms, denial of death in dying patients, their relatives and medical attendants, and delayed or complicated grief reactions.     

Working conditions of traditional birth attendants: some characteristics of rural home situations

This is a study of qualitative and dialectical approach, which subject is to analyze the working conditions of the traditional birth attendants, in a reproductive perspective of work, and for this reason, economically undervalued. The analysis has been constructed having as central category the work, under marxist and feminist premises. Obtained results permit us to state these traditional birth attendants do their work in material and financial poor conditions, related to transportation, access, and still, working environment. The analysis of this practice has given us a possibility to present a discussion on some traits of the traditional birth attendant's work, which is characterized as a reproductive work, economically undervalued, autonomous and eminently feminine. It still configures as a social practice of popular health, legitimated by the community. In the rural domestic obstetrics practice, unequal relations were in evidence since men and women play different roles in the same occupation, being women's responsability the reproduction of the feminine role.     

Craniofacial hyperhidrosis treated with video endoscopic sympathectomy

Craniofacial hyperhidrosis as well as palmar hyperhidrosis is an abnormal state of local excessive sweating of unclear etiology. The hyperhidrosis may be isolated in the craniofacial region or associated with palmar hyperhidrosis. The patient's face is so wet with sweat that their daily activities are often seriously disturbed. To the best of our knowledge, there has been no satisfactory medical therapy, nor any effective surgical treatment reported in the literature. In 1991, we started to treat a patient with such distress using endoscopic ablation of the sympathetic T2 segment, because we mastered the technique after treating a large series of palmar hyperhidrosis patients. Furthermore, we were impressed by concomitant reduction of craniofacial sweating after T2-3 sympathectomy resulting from the relatively different domination of sympathetic supply between the eye and face. It appears possible to relieve excessive sweating of the head and face, without producing ptosis or miosis by ablation of the T2 segment. During the past 2 years, 7 patients with severe craniofacial hyperhidrosis have been successfully treated with the method and all obtained a satisfactory result. No complete Horner's syndrome has been produced except in one patient, who showed a mild and transient left eye ptosis, in whom coagulation of the sympathetic trunk higher than the T2 segment was performed. Intraoperative monitoring of forehead skin perfusion and observation of the change of pupillary size is emphasized during the lesion making. The longest postoperative follow-up was 2 years, with a mean follow-up of 12.4 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vocational diagnosis through assessment of functional limitations.

Diagnosis in rehabilitation counseling requires a relatively precise delineation of client assets and liabilities. This is essential in establishing direction for counseling efforts; it can also aid in evaluating counseling effectiveness by providing a means of grouping cases according to difficulty or types of problems. This paper identifies the disadvantages of present systems of medical and psychiatric diagnoses for these vocational counseling purposes. It discusses some of the methodological issues involved in establishing a new system for recording client problems. The paper also introduces a brief, yet comprehensive inventory of functional limitations which has been developed in the Counseling Psychology Service of the Department of Physical Medicine and Rehabilitation at the University of Minnesota.     

生物型与骨水泥型人工股骨头置换治疗高龄股骨颈骨折

背景：随着人工关节材料、工艺及技术的成熟和发展，人工股骨头置换治疗股骨颈骨折尤其是老年患者有移位的股骨颈骨折日渐普及。目的：观察生物型与骨水泥型人工股骨头置换治疗合并心脏病老年性股骨颈骨折的临床疗效。方法：选择2004年1月至2009年12月天津疗养院骨科中心收治合并心脏病的股骨颈骨折患者35例，其中合并心绞痛型冠心病16例，心肌梗死型冠心病8例，无症状冠心病8例，缺血性心肌病冠心病3例。18例采用生物型人工股骨头置换，17例采用骨水泥型人工股骨头置换。结果与结论：35例患者除1例在术中死亡外，34例均获得随访，随访时间836个月，置换过程中出现3例并发症均为骨水泥型组，其中1例在手术过程中经抢救无效死亡，2例在置换过程中血压下降，呼吸困难，经过抢救后生命特征恢复正常。在随访过程中发现生物型组中2例骨质疏松较严重的患者有部分假体下沉，生物型组优良率89％（16／18），骨水泥型组优良率94％（16／17），提示对于合并严重心脏病的患者适合运用生物型人工股骨头置换，而有骨质疏松的患者适合运用骨水泥型人工股骨头置换。     

Emergency department thoracotomy for trauma: a collective review

A decade of experience with resuscitative thoracotomy for the trauma victim in extremis has been gained since the pioneering efforts of Mattox and his associates in 1974. It appears, from a review of the various reports from different trauma centers, that there is an emergence of a consensus as to the best indications for the procedure. It is generally agreed upon that ERT is fruitless in the patient with severe head trauma or when vital signs were absent at the scene of the injury. In the absence of penetrating thoracic injuries ERT yields a very poor survival in patients without vital signs on admission to the emergency center. It is widely accepted that the best results for ERT are in patients with cardiac tamponade. The prognosis is hopeless in patients without vital signs after sustaining blunt trauma.     

旋转皮瓣在头面部肿物术后皮肤缺损中的应用

目的评价应用旋转皮瓣修复头面部肿物切除术术后皮肤缺损的效果。方法自2015年以来,收治头面部基底细胞癌、鳞状细胞癌、色素痣、血管瘤等切除后皮肤缺损的患者86例,应用旋转皮瓣修复,术中切除病变组织后,在缺损邻近设计皮瓣,在合适层次分离皮瓣后修复创面。结果皮瓣成活良好,无一例有血运障碍,切口均良好愈合,局部组织无明显移位,修复效果满意。结论应用旋转皮瓣修复头面部皮肤缺损,方法易于操作,美容效果良好。     

Society of Critical Care Medicine Critical Care Self-Assessment Program III

Critical Care Medicine encompasses an extremely broad scope. Examination questions were, therefore, chosen to cover a wide variety of critical care topics. A near Gaussian distribution of scores was found for all physician groups studied. We believe the low mean score of 15% reflects the general difficulty of the examination as well as the tendency of many critical care practitioners to master knowledge poorly outside his or her primary specialty. Hopefully, this examination with rationales and references will expose the practitioner to topics and literature with which he or she has not been previously familiar. Only by integrating knowledge from each of the primary specialities can the practitioner provide optimal care for the critically ill. It is our hope that this examination represents a positive learning experience for its past and future participants. If we have stimulated thought, discussion, and further study in the area of critical care medicine, then our efforts in the preparation of this program have been worthwhile.     

Sphenopalatine Ganglion Pulsed Radiofrequency Treatment in 30 Patients Suffering from Chronic Face and Head Pain

Abstract:   This study evaluated the efficacy of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) treatment in patients suffering from chronic head and face pain. Thirty patients were observed from 4 to 52 months after PRF treatment. The primary efficacy measures were the reduction in oral medication use, including opioids, time-to-next-treatment modality for presenting symptoms, duration of pain relief, and the presence of residual symptoms. Secondary objectives included the evaluation of adverse effects and complications. All data were derived from patient charts, phone conversations, and clinical follow-up visits. Fourteen percent of respondents reported no pain relief, 21% had complete pain relief, and 65% of the patients reported mild to moderate pain relief from SPG-PRF treatment. Sixty-five percent of the respondents reported mild to moderate reduction in oral opioids. None of the patients developed significant infection, bleeding, hematoma formation, dysesthesia, or numbness of palate, maxilla, or posterior pharynx. A large-scale study of SPG-PRF for the treatment of face and head pain has not been previously reported. Our results suggest that a prospective, randomized, controlled trial study to confirm efficacy and safety of this novel treatment for chronic head and face pain is justified.     

The Functional Assessment Screening Questionnaire: application for evaluating pain-related disability

The Functional Assessment Screening Questionnaire (FASQ) is a 15-item checklist which was developed for primary care populations and may serve as a questionnaire method for evaluating disability which is associated with chronic pain. One hundred fifty-eight patients completed the FASQ as part of an initial multidisciplinary evaluation of chronic pain. Reliability was reaffirmed through split-half and alternate-form methods. Responses were examined to explore relationships to aspects of disability. Although job functions were not directly assessed, the scores of employed vs unemployed respondents differed significantly. Findings were related to Minnesota Multiphasic Personality Inventory scale scores but appeared to reflect a separate phenomenon. Scale 1 (Hs) was the most useful scale for predicting level of reported impairment. Nonparametric methods showed levels of functioning varying significantly by site of pain complaint. Patients with back pain reported the most difficulty; those with head pain and genital pain reported the least difficulty. An internal structure appropriate to chronic pain populations was discerned, with two general factors measuring either physical-motoric or cognitive-social aspects of disability. Aside from constraints associated with the use of self-report methods, the FASQ may be helpful as part of efforts to portray pain-related disability.     

超声显像诊断胎儿唇裂畸形

超声检查胎儿畸形已在临床广泛应用，但胎儿唇裂畸形报道较少。我院自１９９０年以来把检查胎儿颜面部作为Ｂ超检查的常规内容，至１９９４年９月在我院共分娩的３１７７例新生儿中，共查出唇腭裂畸形３例，无漏诊及误诊。检查方法为：在测量胎儿双顶径后将探头声束朝向胎儿颜面部。胎儿口鼻结构在妊娠２２周后只要检查手法正确均能清楚显示。胎儿姿势对检查很重要，胎儿呈仰卧及侧卧位时较好，如胎头过度仰伸或俯屈应令孕妇活动后复查。     

Cervicogenic headache: Diagnostic evaluation and treatment strategies

Cervicogenic headache is a chronic, hemicranial pain syndrome in which the source of pain is located in the cervical spine or soft tissues of the neck but the sensation of pain is referred to the head. The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibers in the descending tract of the trigeminal nerve converge with sensory fibers from the upper cervical roots. This convergence of upper cervical and trigeminal nociceptive pathways allows the referral of pain signals from the neck to the trigeminal sensory receptive fields of the face and head. The clinical presentation of cervicogenic headache suggests that there is an activation of the trigeminovascular neuroinflammatory cascade, which is thought to be one of the important pathophysiologic mechanisms of migraine. Another convergence of sensorimotor fibers has been described involving intercommunication between the spinal accessory nerve (CN XI), the upper cervical nerve roots, and ultimately the descending tract of the trigeminal nerve. This neural network may be the basis for the wellrecognized patterns of referred pain from the trapezius and sternocleidomastoid muscles to the face and head. Diagnostic criteria have been established for cervicogenic headache but its presenting characteristics may be difficult to distinguish from migraine, tension-type headache, or hemicrania continua. A multidisciplinary treatment program integrating pharmacologic, nonpharmacologic, anesthetic, and rehabilitative interventions is recommended. This article reviews the clinical presentation of cervicogenic headache, its diagnostic evaluation, and treatment strategies.     

实时三维超声在产前胎儿超声检查中的初步应用

目的探讨实时三维超声在产前胎儿超声成像中应用的临床价值。方法对26例孕龄16～41周的正常适龄胎儿进行实时三维超声检查。观察胎儿的心脏、颜面部、头颅、胸腹部各重要解剖结构。实时显示三维图像,或者在检查结束后脱机分析图像。结果26例胎儿均获得满意的实时三维图像,包括心脏、颜面部、头颅、胸腹部结构。其中26例观察了心脏,14例观察了颜面部,12例观察了头颅,6例观察了胸腹部。结论实时三维超声能够实时直观地显示胎儿各部位解剖结构的三维立体图像,比传统的二维超声提供更直观的图像信息,其在胎儿先天性畸形显像及筛查中具有重要的应用价值。     

Preliminary report on AED deployment on the entire Air France commercial fleet: a joint venture with Paris XII University Training Programme

The positive effect of early defibrillation on survival from cardiac arrest has been demonstrated. We describe the use of AEDs over 1 year following the training of flight attendants. Air France and the University of Paris XII together designed a 1 year training programme for 14000 flight attendants. The university emergency departments (SAMU) provided 250 instructors. AEDs training and certification was conducted for crew members between November 2001 and November 2002. By January 2003, all aircraft were fully equipped with AEDs. All cases of cardiac arrest that occurred during the study were reviewed comprehensively. Comments from the crew were collected. Twelve cardiac arrests were reported between November 2002 and November 2003 out of 4194 cases of emergency care delivered to passengers. Shock treatment was advised initially in 5/12 cases. The survival rate after in-flight cardiac arrest was 3/12. The survival rate at discharge from hospital following in flight shock was 2/5. No complications arose from the use of AEDs. Training by professionals gave the flight attendants confidence and allowed for the survival of two young passengers. Our study highlights the ability of flight attendants to give better onboard care for the future. The next step is to consolidate the network between in-flight care and the medical dispatch centre in Paris.