Occupational therapy in acute inpatient psychiatry: an activities health approach.

This article discusses some of the challenges that occupational therapists working in acute psychiatric inpatient settings commonly face. There is often a lack of sufficient time available for treatment as well as limitations inherent in addressing functional problems in the artificiality of a hospital environment. A theoretical framework is introduced from which the role of occupational therapy and realistic objectives for acute short-term care can be identified.

Physiology of blood flow and oxygen utilization by peripheral tissue in circulatory shock.

The primary defect that characterizes circulatory shock is acute perfusion failure, in which oxygen metabolism is critically impaired by decreased delivery of oxygen to tissues. Four categories of hemodynamic deficits are described as the basic mechanisms of circulatory shock: hypovolemia, cardiac failure, distributive deficits, and vascular obstruction. Perfusion failure can be identified by the development of lactic acidosis, because anaerobic metabolism is the consequence of the oxygen deficit during circulatory failure.

Esophageal perforation in a patient with acquired immunodeficiency syndrome.

Infection with Mycobacterium tuberculosis is frequently found in patients with acquired immunodeficiency syndrome and can result in diffuse lymphadenopathy from disseminated disease. A case is presented of esophageal erosion and perforation secondary to mediastinal lymph node enlargement from Mycobacterium tuberculosis in a patient positive for human immunodeficiency virus. Emergent surgical intervention required resection of the perforated esophagus, end-cervical esophagostomy, gastrostomy, and feeding jejunostomy.

Rationale and protocol for postoperative anterior cruciate ligament rehabilitation.

A rehabilitation program for postoperative anterior cruciate ligament (ACL) reconstruction permits adequate tissue healing time and allows early protected muscular conditioning. The program is based on kinematic, biomechanical, and kinesiologic factors as they pertain to ACL function. The program is divided into five phases.

Treatment with bovine hyperimmune colostrum of cryptosporidial diarrhea in AIDS patients.

Cryptosporidium parvum may cause severe, debilitating diarrhea in patients with AIDS. Recent anecdotal reports have suggested that hyperimmune bovine colostrum may be effective. We conducted a double-blind, controlled pilot study of hyperimmune bovine colostrum for diarrhea due to cryptosporidiosis in five AIDS patients.

Cryptosporidiosis in AIDS and non-AIDS patients.

Stool specimens were collected from 433 diarrheal patients (87 AIDS and 346 non-AIDS), among which, 154 specimens from 84 patients (45 AIDS and 39 non-AIDS) had cryptosporidial oocysts detected by acid-fast stain method. The overall incidence of cryptosporidiosis in this study was 19%; however, the incidence in the AIDS patients was almost 5 times of that in the non-AIDS patients. The consistency of 154 specimens having oocysts were 71 (46%) watery, 57 (37%) loose and 26 (17%) soft.

Naegleria and Acanthamoeba infections: review.

Infections caused by small, free-living amebas are still unfamiliar to many clinicians, pathologists, and laboratorians. As of 31 July 1989, more than 140 cases of primary amebic meningoencephalitis caused by Naegleria fowleri and more than 40 cases of granulomatous amebic encephalitis caused by Acanthamoeba species (including two cases in patients with AIDS) and possibly by other free-living amebas had occurred worldwide. The recent increase in acanthamoeba keratitis (more than 200 cases), especially in contact lens wearers, has generated new interest in this group of amebas.

Opportunistic infections of the testis in the acquired immunodeficiency syndrome.

The testes of an autopsy sample of 56 patients with acquired immunodeficiency syndrome (AIDS) and systemic opportunistic infections were studied for the presence and type of testicular infection. Light-microscopic evidence of opportunistic organisms (cytomegalovirus, Mycobacterium avium-intracellulare, and Toxoplasma) was present in 22 cases (39%). Based on the prevalence and histologic features of the testicular infections and the biological characteristics of the specific organisms, the possible sexual transmission of opportunistic organisms in AIDS is discussed.

Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain.

An attempt was made to determine the effect of pregnancy on the abdominal muscles and to correlate changes in abdominal muscles strength with low-back pain during pregnancy. The study included 328 women. Group A consisted of 164 pregnant women; group B consisted of 164 non-pregnant women.

Experience with intravenous immunoglobulin in myasthenia gravis.

Myasthenia gravis (MG) is an acquired autoimmune disorder of neuromuscular transmission associated with a deficiency of acetylcholine receptor at the neuromuscular junction. Current therapeutic strategies are aimed at increasing the amount of acetylcholine at the neuromuscular junction or at addressing the abnormal immune response. Therapies influencing the immune response include thymectomy, corticosteroids, nonsteroidal immunosuppression, and plasmapheresis.

Chronic lymphocytic leukemia with hypothalamic invasion.

Headaches and a state of confusion developed in a patient with chronic lymphocytic leukemia (CLL). A computed tomography (CT) scan of the head showed a hyperdense lesion in the hypothalamus with obstruction of the foramina of Monro. Leukemic cells with monoclonal lambda B-cell markers were identified in the ventricular fluid at the time of surgical decompression.

Diabetic microangiopathy in patients with cystic fibrosis.

Individuals with cystic fibrosis have a 1% to 7% incidence of insulin-dependent diabetes mellitus. The occurrence of diabetic microangiopathy in patients with cystic fibrosis has been reported recently. From 1978 to 1987, 19 patients with cystic fibrosis and diabetes mellitus were followed up.

Night backache in pregnancy. Hypothetical pathophysiological mechanisms.

One hundred women responded to a questionnaire dealing with night backache during pregnancy. All the women were in the second half of their pregnancy. Sixty seven per cent of the women reported discomfort and/or backache during the night.

A surgical approach to the motor branch of the ulnar nerve.

Isolated injury to the motor branch of the ulnar nerve is a relatively rare injury, often initially misdiagnosed. If repair is attempted through the original laceration without complete motor branch exposure, results can be less than satisfactory. A recent case illustrates this injury and provides us with an opportunity to review the surgical anatomy of the motor branch of the ulnar nerve.

Internal mammary artery bypass grafting: influence on recurrent angina and survival in 2,100 patients.

Internal mammary artery (IMA) bypass grafting to the anterior descending coronary artery was performed in 2,100 patients between January 1978 and July 1986. The average number of additional saphenous vein grafts (SVGs) per patient was 1.8.

The relationship of the abdominal aortic aneurysm to the tortuous internal carotid artery. Is there one?

During our investigation of the tortuous internal carotid artery in the presence of atherosclerosis, we noted a 44% incidence of abdominal aortic aneurysm. The incidence of abdominal aortic aneurysm in the adult population is 2% to 4%, and the incidence in a group of patients with carotid atherosclerosis has been reported to be 10%. This supports an association between the tortuous internal carotid artery and the abdominal aortic aneurysm independent of other risk factors.

Recommendations for control and prevention of human immunodeficiency virus (HIV) infection in intravenous drug users.

Considerable evidence indicates that intravenous drug users are emerging as the group at greatest risk for both acquiring and spreading human immunodeficiency virus (HIV) infection. Thus, all possible methods to control the spread of HIV infection in intravenous drug users should be explored. Key recommendations are that HIV antibody testing of intravenous drug users should be voluntary, because mandatory testing is counterproductive; free distribution of needles and syringes to intravenous drug users should occur only in carefully controlled circumstances to determine its effectiveness in decreasing infection rates; and drug-free and methadone maintenance treatment programs should be available on demand to all intravenous drug users as a means of reducing the spread of HIV infection.

Multiple jejunal perforations secondary to cytomegalovirus in a patient with acquired immune deficiency syndrome. Case report and review.

Disseminated cytomegalovirus infection in patients with AIDS usually involves the lungs, retina, esophagus, or colon. Gastrointestinal involvement may present clinically with fever, intractable diarrhea, and crampy abdominal pain. Ulcerations have been seen throughout the gastrointestinal tract, but perforations have been confined to the terminal ileum and colon.

Testicular atrophy in AIDS: a study of 57 autopsy cases.

The pertinent clinical data and histologic features of the testes in 57 autopsied acquired immunodeficiency syndrome (AIDS) patients were analyzed and compared with those of 55 age-matched control patients without AIDS. The testes of the AIDS patients showed a significantly lower degree of spermatogenesis (determined by a testicular score count), as well as more prominent thickening of the basement membrane and interstitial fibrosis when compared with the controls. While the precise cause of testicular atrophy in AIDS patients remains to be determined, the chronicity of the disease, prolonged fever, malnutrition, testicular infection, and chemotherapy are all contributing factors.

Internal mammary artery bypass: effect on longevity and recurrent angina pectoris in 2900 patients.

Internal mammary artery bypass (IMA) to the anterior descending coronary artery was performed in 2900 patients from January 1978 to December 1987. The average age of the patients was 64 years. Males accounted for 68% (1972 patients) and 82% (2378 patients) were in New York Heart Association (NYHA) class III.

Single photon emission computed tomography (SPECT) with [123I]IMP in the differential diagnosis of psychiatric disorders.

Single photon emission computed tomography (SPECT) with [123I]N-isopropyl iodoamphetamine--[123I]IMP--was used to study regional cerebral blood flow (rCBF) in 94 psychiatric patients and six controls. Patients with dementias had distinct brain-image patterns, consistent with the expected neuropathology. Major depressives had decreased cortical and subcortical rCBF.