Head injuries in children: a chronicle of a quarter of a century

Children aged 0–15 years hospitalized in Geneva for head trauma during the last quarter of a century are reviewed. More than half of the severely injured children were not from Geneva area. New methods of management have been introduced progressively. The cases are divided in four successive time periods and classified according to their pathology. A continuous improvement in mortality is obvious, decreasing from 29.4% to 2.2%, but climbing again to 15.2% in the last period, probably due to more severe pathologies. For the Geneva area the mortality decreased progressively from 10.4/100 000 to 3.5/100 000 annually, due to better organization and management, but also to a drop in the incidence of severe cases from 35.5–13.5/100 000 per year. A decrease in the number of traffic accidents is responsible for this. However, the number of handicapped children has not changed.     

Experimental research of a set as a means of a set as a means of understanding specific characteristics of psychological constitutions

Primary specific characteristics of psychological reactions, typical of the individual and undoubtedly influencing the formation and dynamics of his character, can be defined as "psychological constitution." Experimental study of peculiarities of an individual's set by the method elaborated by D.N. Uznadze and his school was chosen as a way to elicit psychological constitution. The manner in which the subject creates a model of the situation and the rate at which this model is destroyed when it fails to correspond to the perceptual data, appear to be the central question. A conceptual approach is suggested for evaluation of experimental data as characteristics of the individual's psychological constitution. It turns out thereby to be possible, theoretically and experimentally, to single out 8 basic types of psychological constitutions, or "primary psychotypes."     

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.     

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.     

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.     

Importance of the recognition of a warning leak as a sign of a ruptured intracranial aneurysm

In the Danish Aneurysm Study 1076 patients (pts.) were admitted with an aneurysmal subarachnoid hemorrhage in the 5-year period 1978-83. A warning leak (WL), defined as a sudden episode of headache, vomiting, nuchal pain, dizziness or drowsiness, was identified in 166 pts. (15.4%). In 99 of these the episode was evaluated by a physician but misdiagnosed. A 2-year follow-up examination of the 99 pts. showed that 30 pts. had a normal mental outcome and 43 pts. were dead. If these patients were correctly diagnosed after the WL, when they were in Hunt grade 1-2, the outcome-figures would probably have been significantly better. A theoretical transfer of the outcome-probabilities for pts. in Hunt grade 1-2 to the above mentioned 99 pts. would result in 66 pts. with a normal mental outcome and 25 dead pts. This shows the importance of recognition of a WL episode.     

The psychological development of a twin: a case study of the importance of a symptom

In this paper we focus on the evaluation, assessment, diagnostic conclusions, and individual psychotherapy of a four year old twin who presented with the symptom of encopresis. Of great relevance to this boy is the literature concerning his vulnerability as a twin to develop symptomatology as he starts dealing with separation and individuation issues. Especially relevant are the multiple impacts of attitudes, perceptions and family rearing issues on the psychological development of this twin, and also on the development of this specific symptom choice--encopresis. Incorporating literature with case material, the meaning of the symptom of encopresis to this twin is discussed. The hypothesis defended is that the symptom enabled the twin to attract attention from his somewhat favoured brother, and to promote the process of separation and individuation from his parents and from his twin. It promoted his sense of himself as a separate and unique person in his own right. The child developed a sense of himself despite parental interference. With individual psychotherapy and family therapy, the need for the symptom was neglected.     

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.     

Portrait of a sadist as a young man

Treatment of chronically violent patients poses problems for the therapist in a number of ways. Institutional demands, concern for one's personal safety, and psychotic transferences are common. This case details the treatment of one young violent offender.     

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.     

Change in a schizophrenic adolescent as a result of a series of rage-reduction treatments.

A 15-year-old schizophrenic girl with many autistic features was observed to have minimal gains from verbal (individual and family) psychotherapy. A course of six rage-reduction sessions was carried out. Effects of the treatment was assessed by daily ratings made by attendants in the ward setting and by a recreation therapist. Both short term and long term effects were assessed. Short term improvement was noted in the ward ratings on dimensions assessed: eye contact when requested; eye contact, spontaneous; speech quality; expression of feelings; interaction with peers; frequency of autistic behaviors; and interaction with adults. In recreation therapy (using fewer observations), short term improvements were noted in all except two of the dimensions: eye contact, spontaneous; and interaction with peers. Long term (pretreatment vs. post-treatment) gains were evident in the ward ratings on all areas except expression of feelings. In the recreation therapy setting, only frequency of autistic behavior showed a stable improvement. The therapist working with the patient also noticed more global changes, and suggested that rating such dimensions as depth of self-disclosure and willingness to confront important issues in verbal psychotherapy would also show interesting results. Methodological weaknesses of the study are mentioned, and guidelines for future work on this problem are suggested.     

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.     

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.