Patient and spouse expectations of and reactions to continuous subcutaneous insulin infusion (CSII) therapy: case report

Six insulin-dependent women with diabetes and their spouses were assessed (1) prior to continuous subcutaneous insulin infu sion (CSII) therapy, and (2) three months after implementation of CSII therapy. The pre-CSII interviews revealed that both patient and spouse were interested in the positive emotional conse quences of improved metabolic control. How ever, patients were most interested in the personal benefits of metabolic stabilization, whereas spouses were more con cerned about potential improvement of the marital relationship. Post- CSII interviews showed that most fears regarding CSII therapy expressed in the pre-CSII interview were not realized, but many unanticipated negative and positive responses to treatment were experienced.

Airway obstruction and sleep apnea in Hurler and Hunter syndromes

The Hurler and Hunter syndromes are two forms of mucopolysaccharidosis. Although the diseases are rare, those afflicted commonly require otolaryngologic consultation. Upper airway obstruction is often severe, progressive, and not infrequently the suspected cause of death in these patients. Four patients with these problems are presented. In all of the children, obstructive sleep apnea was a major management problem. This and other upper airway difficulties are detailed with clinical and pathological correlates.

Maxillary ameloblastoma with orbital invasion. A clinicopathologic study

A 72-year-old white man presented to Massachusetts Eye and Ear Infirmary with proptosis of the right eye. Computerized tomography (CT) scan revealed a mass which filled the right maxillary sinus and invaded the orbital and middle cranial cavities. Six years earlier, the patient had excision of an ameloblastoma of the right maxillary antrum. The tumor recurred, requiring maxillectomy, local radiotherapy and finally exenteration. Ameloblastoma is a relatively rare epithelial tumor arising from embryonal tooth elements. It is locally invasive and recurrent but rarely metastasizes and extension to the orbit is extremely unusual. The clinical features, histopathologic findings and treatment of this tumor are discussed. Differential diagnosis of jaw tumors, which may invade the orbit, is reviewed.

Vertebral bone mineral content in osteogenesis imperfecta

Quantitative computed tomography of the lumbar spine was carried out in 28 patients with osteogenesis imperfecta (OI) in order to measure vertebral trabecular bone mineral concentration (BMC). The patients ranged in age from 6-73 years, and included 3 of the 4 major clinical subtypes of the disease. The findings underscore the heterogeneity of osteogenesis imperfecta even among family members with the same disease type. In addition, cross-sectional analysis of Type I OI patients suggests that BMC during young adulthood averages about 70% of normal, and subsequently falls more rapidly than in normal patients. BMC tends to be lower in the more severe forms of OI. Decreased BMC was not found in a few otherwise normal relatives with scoliosis or joint laxity.

Employer perspectives on the preferred provider organization concept

The goal of preferred provider organizations (PPOs) is to identify cost effective physicians, hospitals and other providers and form them into healthcare delivery systems. Widespread interest in PPOs stems from the belief that they can contain costs while offering consumers a choice of physicians and hospitals. But there is little information available about the demand by employers to offer PPOs as a health plan option. This study gathered information on employers' attitudes toward PPOs through a survey of companies in the Minneapolis metropolitan area. Most of the surveyed firms were found to be self-insured and offered a choice of healthcare plans, including HMOs. Contrary to some previous studies, healthcare costs are a major concern by all of the firms. PPOs are viewed as one part of an overall strategy to reduce those costs while maintaining quality of care and convenient access to providers. Although somewhat skeptical about potential savings and concerned over the administrative costs of offering a new health plan, most of the firms indicated support for the PPO concept. The greatest market opportunity for PPOs is to offer the plan as an alternative within the company's existing indemnity plan, wherein employees who use the preferred providers are exempt from at least a portion of the coinsurance and deductible requirements.

Personality and family profiles of chronic insulin-dependent diabetic patients using portable insulin infusion pump therapy: a preliminary investigation

Thirty patients were studied before and after introduction of portable insulin infusion pump therapy to determine the psychological and family impact of this new technological intervention. No negative psychological impact or dysfunction appeared to be associated with introduction of the pump. On the contrary, the postpump group reported significantly less depression, significantly less anxiety, and significantly greater family cohesion than the prepump group. Other nonsignificant trends were in a direction indicating improved individual and family psychological status.

Arthrography (plica views). A noninvasive method for diagnosis and prognosis of plica syndrome

In 45 patients with chronic knee problems arthrograms of the knee were obtained with emphasis on plica views. Thirty arthrograms showed radiographic evidence of plica syndrome. Three patients had thin bands in the proximal part of the suprapatellar pouch. Four patients had infrapatellar plicae. Eighteen patients had suprapatellar plicae, and five had mediopatellar plicae. The cross-table lateral view of the knee in different degrees of flexion is a valuable prognostic method. Five patients with suprapatellar plicae demonstrated excursion of the thick fibrotic band over the anteromedial femoral condyle during arthrography with the knee in different degrees of flexion. These patients did not respond to conservative treatment and required surgical excision of the plicae. Cross-table anteroposterior and tangential views with the medial side of the knee facing upward demonstrate impingement of the medial femoral condyle or the medial facet joint of the patella by the fibrotic mediopatellar plica. All patients (5 of 5) with mediopatellar plicae required surgical excision of the plicae.

"Self-control" concerns for men and women: refinement and extension of a construct

This study develops and refines aspects of the construct of self-control according to a four-quadrant model: Assertive-positive, assertive-negative, yielding-positive, and yielding-negative. Twenty-six men and 78 women evaluated areas of their life in terms of the perceived degree to which they utilized these various dimensions of control. Results indicated that, depending on the specific area of clinical concern (e.g., interpersonal relationships, professional pursuits, emotional expression, health), there were significant differences in the kinds of self-control strategies that Ss tended to employ. From a clinical perspective, while Ss in this sample exercised a high degree of assertive-positive control in their professional lives, in the interpersonal and affective spheres they perceived themselves to be more out of control and exercising more negative-assertive control.

Part II. Amyoplasia: twinning in amyoplasia--a specific type of arthrogryposis with an apparent excess of discordantly affected identical twins

We report on 11 cases of amyoplasia in one of identical twins. In total, 135 patients with amyoplasia were ascertained from a study of 350 patients with multiple congenital joint contractures (arthrogryposis). These 11 cases of identical twins with amyoplasia represent 8% of our patients with amyoplasia. At least 18 sets of twins with congenital contractures have been reported previously. However, only four of these appear to involve identical twins discordant for amyoplasia. Thus, 15 cases in which only one of identical twins are affected with amyoplasia have been identified.

Lessons from the Silica "Decline" in Lake Michigan

A new analysis of data obtained from water treatment plants on Lake Michigan fails to support published contentions, based on such data, that the silica content of the lake has declined during the last five decades. The purported silica decline appears to have been due to changes in analytical methods and laboratories. Had such changes been avoided, an invaluable record of the silica content of the lake could have been obtained.

The role of diet in the etiology and treatment of atherosclerosis

The role of various dietary constituents in the etiology of hyperlipidemia and cardiovascular disease is examined in light of currently available data from epidemiological and clinical studies. Recommendations regarding the dietary management of the hyperlipidemic patient at risk are presented and the advisability of generalized dietary guidelines for the public examined. The certainties, which are few, and the uncertainties, which are numerous, regarding the cause and effect relationship between diet, hyperlipidemia, and cardiovascular disease suggest that dietary intervention to treat the hyperlipidemic patient is a rational first step but that the generalization of this approach for the public may be premature.

Patients', medical students', and physicians' perceptions of male and female physicians

Using data from the Bern Sex-role Inventory, this study examined the hypothesis that male and female physicians are perceived differently both by their patients and by other physicians and medical students. This hypothesis was confirmed. Not only were significant differences in profiles of male and female physicians noted, but differences were also found among the three groups surveyed. Further, some of the differences in perception of male and female physicians were related to the sex rather than the group identity of respondents. Female patients, and to some extent female medical students, tended to view women physicians most often as androgynous and feminine. Male medical students tended to view women physicians in reverse pattern, i.e., most often feminine and then androgynous. Male physicians viewed the woman physician most often as feminine, like medical students, and then as undifferentiated. Both male and female patients and medical students tended to view the male physician most often as undifferentiated and masculine. Male physicians viewed their male colleagues most often as clearly masculine. Implications of these differences for residents' training and quality of patients' care are discussed.

Family reactions and coping strategies in response to the physically ill or handicapped child: a review

This article reviews a broad range of clinical and research material investigating the coping processes of individuals and families, particularly in response to a serious illness or handicapping condition in a child family member. The interactive effects of family and illness are established; then several theoretical, descriptive and empirical theories of coping are presented. Coping responses of family members and the family unit as a whole to minor illness, to chronic illness and handicapping conditions, to childhood cancer, and to death in childhood are all discussed. The article concludes with a discussion of the implications and benefits for the physician and other health care professionals in adopting a family-oriented treatment approach.

Cost effectiveness of individual vs. group cognitive behavior therapy for problems of depression and anxiety in an HMO population

Randomly assigned 44 outpatient Ss, enrollees of the George Washington University Health Plan, a Health Maintenance Organization (HMO), to one of three treatment modalities: (1) a cognitive behavior therapy group; (2) a traditional process-oriented interpersonal group; and (3) cognitive behavior therapy in an individual format. All Ss were referred by their physicians to the HMO Mental Health Practice for treatment for anxiety and/or depression. Beck's Depression Inventory, Speilberger's State-Trait Anxiety Inventory and Gay and Galassi's Adult Self-Expression Scale (an assertion measure) were administered pre- and post-treatment to all Ss. A subsample of these Ss also were rated pre- and post-treatment on the Hamilton Rating Scale for Depression by experienced clinicians blind to the treatment groups. All three experimental groups significantly improved on all dependent measures from pre- to post-treatment, and no differential treatment effects were found.