Relationships between physical and mental illness

A random sample of the general population of a southeastern county was studied to examine some relationships between reported physical illness and mental disorders. Results, obtained from epidemiologic data, indicate that lower socioeconomic status is probably the most fundamental factor associated with high risk for both physical and mental illness.     

Granular cell myoblastoma arising from the thoracic sympathetic nerve chain.

Granular cell myoblastoma has been of interest both to the clinician and the pathologist for many years. This uncommon tumor presents the usual diagnostic problem of a mass, but the actual diagnosis of granular cell myoblastoma is rarely made prior to biospy. The origin of the tumor from either myoblastic or neural tissue remains controversial. Light and electron microscopic studies of a granular cell myoblastoma uniquely located in the posterior mediastinum and associated with the sympathetic chain support the neural origin of this tumor.     

Fiberoptic endoscopy: Precise definition of upper gastrointestinal disease

When properly employed, endoscopic examination of the upper gastrointestinal tract with the flexible maneuverable-tip fiberoptic instruments is the most accurate method of diagnosing any upper gastrointestinal tract disease. Two hundred consecutive endoscopic procedures in the upper gastrointestinal tract were performed without significant morbidity or mortality; the results were reviewed to ascertain the overall diagnostic value of this modality. Although the overall numbers in each subgroup are still small, the experience indicates that: (1) thorough endoscopic examination of the upper gastrointestinal tract can be carried out expeditiously in most patients without morbidity; (2) upper gastrointestinal tract disease can be precisely defined in the majority of patients; and (3) endoscopic examination frequently alters the initial clinical diagnosis. The precise cause of upper gastrointestinal tract hemorrhage can be diagnosed in at least three of four cases. Some unnecessary operations can be avoided and proper therapy for specific sources of bleeding can be initiated promptly.     

Changing concepts in head and neck surgical oncology

Preoperative infusion of volume to increase the wedge pressure will maintain stable flow and arterial pressure at the time of aortic declamping. Usually 1,500 ml of balanced salt solution given with 75 g of albumin is sufficient to accomplish this purpose. Pressor or inotropic agents are not required. In our experience 14 percent of patients will have a down-slope in the preoperative myocardial performance curves. In these persons, volume infusions should be adjusted to keep the pulmonary arterial wedge pressure on the ascending portion of the curve. The use of vasodilator agents in normotensive patients has a deleterious effect on cardiac performance.     

Phased biofeedback approach for epileptic seizure control

A phased biofeedback method for seizure control was used in an 18-yr-old female. Based on reports that epileptic seizures can be prevented by EEG biofeedback, we employed a phased sequence of relaxation training, EMG feedback, and feedback of alpha and theta EEG frequencies, to develop a low arousal, anti-stress response. Intervention over a 1-yr period resulted in a 46 per cent decrease in monthly seizures. Follow-up showed maintenance of her decreased seizure activity. Self-report and charges in locus of control orientation affirm the learning of an effective anti-stress response.