DIAGNOSIS AND TREATMENT OF GLAUCOMA—A Review of Recent Developments

Tonography is helpful in the diagnosis of doubtful cases of chronic simple glaucoma. If also gives a good indication of the status of the disease in a given eye.The most useful miotic in the treatment of glaucoma is still pilocarpine. Carbachol is more potent but must be used in an anhydrous base ointment or in a solution of a wetting agent. DFP (diisopropyl fluorophosphate) produces undesirable side effects because of the hyperreactivity of the ciliary body and iris sphincter which it causes. These can be partly overcome by using pilocarpine first. Diamox is a carbonic anhydrase inhibitor that is effective when given orally. In many cases it produces at least a temporary lowering of tension in glaucomatous eyes, apparently by reducing the secretion of intraocular fluid. Its ultimate value in glaucoma remains to be seen.The cyclodiathermy operation which has been modified somewhat by Weekers has had a recent increase in use but the long-term results have been somewhat disappointing.The importance of early operation in narrow angle glaucoma is becoming more and more apparent. Following iridectomy the wound should be tightly sutured to insure the prompt reformation of the anterior chamber.     

ENDOMETRIOSIS—A Review

Endometriosis, the cause of which is unknown, is on the increase. Treatment is surgical—conservative in the childbearing years. Hormonal therapy is sometimes palliative for a time, and the disease may regress during pregnancy. Endometriosis of the bowel should be borne in mind in the differential diagnosis of partial obstruction.The literature contains reports of 14 cases of ovarian carcinoma arising from endometriosis.     

RENOVASCULAR HYPERTENSION—A Review

Recognition of renal artery occlusion as a cause for hypertension is resulting in a systematic search for the patient with a potentially curable vascular lesion. Radioisotope renography, differential renal function studies and renal arteriography serve as screening studies to aid in the diagnostic evaluation. Vascular reconstructive operation was employed in 13 patients.     

The LSD Syndrome—A Review

lsd (lysergic acid diethylamide) is a powerful bio-active substance related to serotonin in structure. Its actions generally affect autonomic, sensory and psychological functions. Autonomic stimulation is varied. Sensory responses are usually visual, involving heightened and distorted color perception and fusion of sensory impressions. Psychological responses include a feeling that a unique experience is occurring; feelings of depersonalization; pronounced fluctuation of mood; time and space distortions; autistic phenomena; fluctuation of aggressive drives (usually reduction); and spontaneous reoccurrence of the lsd experience.The subjective responses can be related to three basic phenomena: (1) expectation; (2) loss of characteristic modes of perceptual and cognitive patterning; and (3) hypersuggestibility.The major adverse reactions are: (1) chronic drug dependence including subsequent personality changes and depressive reactions; and (2) acute ego dissolution. These reactions usually occur in already emotionally ill people. Most of these users fall into two groups, those with unresolved identity problems and those with severe ego abnormality. The majority of adverse reactions are of the chronic drug dependence type and are usually seen in adolescents and young adults who have not negotiated the age-appropriate tasks of forming and integrating the various identities that are the composite of their life experiences.lsd helps alleviate these stresses via some of its psychological properties as discussed. It also provides a nidus for the formation of a subculture where goals for social, sexual and vocational achievement are lower and idiosyncratic modes of adaptation are better tolerated. A smaller group of users who have serious reactions such as psychosis, rage reactions, homicidal and suicidal ideation are usually found to have preexisting ego abnormality such as ambulatory schizophrenia, chronic impulse disorders and borderline states. Although adverse reactions most often appear to be related to pre-morbid psychopathology, this is not invariably so. Further, there is as yet no reliable method to determine who will have an adverse reaction and what the nature of that reaction will be.     

PSYCHOSIS AND SYSTEMIC LUPUS ERYTHEMATOSUS—A Review of the Literature and Case Reports

In a review of the literature of the last 60 years concerning the association between psychosis and systemic lupus erythematosus, reports of 227 cases of this association were found. The average incidence of psychosis in the various series of systemic lupus erythematosus that were reviewed was 22 per cent. In only 25 per cent of the cases in which the information was given was the psychosis associated with steroid therapy.The psychiatric manifestations are variable and may be associated with a neurological disorder. Psychosis may antedate by many years other features of lupus. The psychosis due to lupus may respond to steroid therapy. Since systemic lupus erythematosus sometimes may be an important differential diagnosis of functional psychosis, appropriate diagnostic studies should be carried out in psychotic patients who have an accelerated sedimentation rate or positive serological test for syphilis without apparent reason.     

BACTERIAL MENINGITIS AND OTHER DISEASES AFFECTING THE MENINGES—A Review of 349 Cases

Three hundred and forty-nine cases of disease affecting the meninges were observed at the San Bernardino County Charity Hospital in an eight year period.A total of 29 patients with meningococcal, H. influenzae and pneumococcal meningitis were treated. There were four deaths, of which three occurred during the first 24 hours in the hospital.Of 22 cases of unclassified meningitis, four probably were tuberculous, four probably were meningococcal and two probably were of virus origin.Under present treatment programs the differentiation between viral and bacterial meningitides is difficult and it is possible, therefore, that the reported incidence of the two groups may not represent the facts.Of 22 cases of unclassified meningitis, 12 had no specific characteristics which would permit a clinical diagnosis. One of the patients died.Of 70 cases of clinical meningitis, the infecting organism was identified in 69 per cent.Meningococcal meningitis made up only 17 per cent of 70 cases of purulent meningitis observed between July 1, 1945, and July 1, 1948.     

THE ETIOLOGY OF SCHIZOPHRENIA—A Review

The causes and the nature of the psychiatric disorder labeled schizophrenia remain vexingly obscure. Perhaps as an expression of a still extant body-mind controversy, most of the experiments and statements made toward an elucidation of the problem follow one or the other of two opposing postulations: (a) That its origin is genetico-organic; (b) that it is environmental. In a review of the outstanding “facts” for either argument, it is notable that they presuppose not only a difference in theoretical frameworks, but two radically distinct outlooks. This is reflected in therapy, a field in which organicists and environmentalists stand even further apart; the organicist, relying heavily on electroshock and drugs, hopes to counteract a hypothetical body malfunction, and the environmentalist, through psychotherapy, attempts to make it possible for the patient to disentangle his own conflicting feelings and reaction patterns.Between the two an eclectic position seems hardly tenable. For, in spite of voluminous research and speculation, it has not been possible to build a bridge between the two camps and integrate different outlooks which, at times, have brought psychiatry almost to the point of schism.     

Biohydrometallurgy for Nonsulfidic Minerals—A Review

Bioleaching is a technology applicable to metal extraction from low-grade ores, ore beneficiation, coal beneficiation, metal detoxification, and recovery of metals from waste materials. The technology is environmentally sound and it may lower operational cost and energy requirement. Whereas leaching of sulfidic minerals using chemolithoautotrophic bacteria is the most studied and commercially exploitable aspect of mineral biotechnology today, there is a dearth of literature on the dissolution of nonsulfidic minerals. Biohydrometallurgy of nonsulfidic minerals involves the action of heterotrophic microorganisms. Heterotrophic bacteria and fungi have the potential for producing acidic metabolites that are able to solubilize oxide, silicate, carbonate and hydroxide minerals by reduction, acidolysis and complexation mechanisms. It is an important aspect of biohydrometallugy that requires development to meet future needs.     

Space Medicine—A Review of Current Concepts

Space medicine deals with the branch of research involved with the adaptation of humans to the unique environment of space. More than 100 people have traveled in space. The day will come when some human beings will spend all their time in space. Medical problems encountered in space, such as motion sickness, negative nitrogen and calcium balance, anemia and radiation exposure, are issues that already affect medical practice outside aerospace medicine.     

TRANSURETHRAL PROSTATECTOMIES—A Review of 560 Cases

Of 560 prostatectomies in an 11-year period on patients with benign or malignant disease of the prostate gland, almost 98 per cent were done transurethrally.Although many of the patients were considered to be in poor condition preoperatively, results achieved by the transurethral operation were excellent or good in 91 per cent of those who had benign disease of the prostate and in 84 per cent of those with malignant invasion. The rate of deaths attributable to the operation was 3.1 per cent in the group of patients with benign disease, 5.3 per cent in patients who had cancer.Complications, such as urinary incontinence, persistent pyuria, epididymitis, strictures of the urethra and of the meatus, and contracture of the neck of the bladder, arose in a surprising number of cases.     

8-METHOXYPSORALEN—A Short Review and Comment

8-Methoxypsoralen is a purified extract of the root ammi majus lynn, which was used in a crude form for centuries in the Middle East in the treatment of various skin diseases. In recent years it has been found that the purified extract, when taken internally, increases all skin responses to sunlight, including tanning. When too much drug is taken or when the patient is exposed to sunlight too long, the preliminary erythema may be painful, and blistering may occur. In some patients with vitiligo, islands of pigmentation appear around the hair follicles when the drug is taken, and in favorable cases these islands may coalesce to form continuous areas of pigmented skin. The drug has been found nontoxic, but successful treatment of vitiligo takes place in only a small proportion of patients.Promiscuous use of the drug for cosmetic tanning is to be deplored. The constant irritation of the skin due to the increased action of sunlight when the drug is used may possibly increase the incidence of sun-induced skin cancers.A topical preparation is available, which, when used with great care, may help to repigment small areas of vitiligo.     

MULTIPLE MYELOMA—A Review of 26 Cases

Multiple myeloma is a rare, malignant disease of bone marrow which affects principally the vertebrae, ribs, pelvis and skull but may involve any part of the skeleton. Severe demineralization and destructive lesions of bones, producing severe pain and debility, are distinctive features. The disease is further distinguished by abnormalities of blood proteins and in some cases by the excretion in the urine of Bence-Jones protein, which seldom, if ever, is found in association with any other disease.X-ray examination is frequently helpful. In 22 of 24 cases (of a series of 26 cases) in which films were available, definite abnormalities were noted. Spontaneous fractures, particularly of vertebrae, are common.The diagnosis of the disease rests on the identification of the myeloma cell. This is best accomplished by aspiration of bone marrow. In several of the 26 cases in the series diagnosis was made by a neurosurgeon at the time of operation to relieve pressure on the spinal cord. The myeloma cell has a very characteristic appearance.In the present series the average duration of life after the onset of symptoms was only nine months. One patient, however, survived for at least ten years.     

Measurement of Physician-Patient Communication—A Systematic Review

Background

Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients'' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures.

Methods

A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues.

Results

Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.''s criteria was rated mainly intermediate or positive.

Discussion

This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of psychometric property studies as well as the comparability of the studies'' results.