Fatal attraction: the ethical and clinical dilemma of patient-therapist sex

This article reviews the existing literature on the subject of patient-therapist sexual contact. Seven point one percent to 10.9% of male therapists and 1.9% to 3.5% of female therapists admit to engaging in intimate contact with patients. Offenders tend to justify their behaviour as being at least innocuous if not beneficial for the patients. The consequences to the patients include increased psychological and psychosomatic complaints, greater mistrust and anger towards men, hospitalization and suicide. Transference and countertransference issues which account for this behaviour are explored as is the issue of post-termination involvement. Education of physicians and residents concerning the temptations and dangers of this type of contact is strongly recommended.

Prevalence of cryptosporidiosis in patients undergoing endoscopy: evidence for an asymptomatic carrier state

PURPOSE

We sought to determine the presence of the parasite cryptosporidium in the duodenal aspirates of patients undergoing routine upper gastrointestinal endoscopy.

PATIENTS AND METHODS

The study consisted of 169 patients undergoing upper endoscopy or endoscopic retrograde cholangiopancreatography. Immunocompromised patients were not included in the study population. Samples were aspirated from the second portion of the duodenum. Biopsy specimens were also obtained. Three randomly passed stool samples were obtained from 75% of the patients who were found to have cryptosporidium in the duodenum.

RESULTS

Overall, cryptosporidium oocysts were identified in 12.7% of patients. There was no significant difference in the prevalence of the parasite in any subgroup of procedure or symptom complex. Half of those (46.7%) with positive aspirates had demonstrable cryptosporidium in stool samples, although none of the patients had diarrhea. No patient had detectable cryptosporidium in biopsy samples of the duodenum.

CONCLUSION

The findings suggest a surprisingly high asymptomatic carrier rate for cryptosporidium.

Long-term oxygen therapy: financial and future consideration

Many persons with lung disease require the use of supplemental low-flow oxygen, which has been shown to reduce the physiological effects of hypoxemia, increase exercise tolerance, and improve t he user's sense of well-being. This article discusses three systems used for long-term delivery of oxygen, the financial considerations of these systems, and developments in the new technology of oxygen-conserving devices, which may decrease oxygen consumption and costs while providing increased comfort and mobility for users.

Forecasting cataract surgeries and intraocular lens implantation to 1990 using a model of population dynamics

Extending the recently observed dramatic growth rates of cataract surgery and intraocular lens implantation into the future is not necessarily valid because of changes in population size, new incidence of cataracts, and rates of treatment for patients diagnosed in current as well as in previous years. Accelerated treatment of the pool of previously diagnosed patients caused a sharp growth in cataract surgery since 1980, but at the same time reduced patients and thus the potential for continued high growth rates. This paper describes a model that produces forecasts through explicit consideration of the many aspects of population dynamics. It provides an opportunity to examine how forecasts might vary under different assumptions about advances in medical technology.

Prenatal diagnosis and management of congenital defects of the anterior abdominal wall

Between the years 1980 and 1985, 25 cases of anterior abdominal wall defects were identified within the University of Toronto Perinatal Complex. There were 17 cases of omphalocele and eight cases of gastroschisis. Associated anomalies were found in 71% of infants with omphalocele and 50% with gastroschisis. They were the major cause of neonatal death. Prematurity was the second most common cause of death. The neonatal death rate was 59% in omphalocele and 38% in gastroschisis; the prematurity rates were 53% and 50%, respectively. In omphalocele, there was a 47% cesarean section rate, with a 50% neonatal death rate. Vaginal delivery was associated with a 67% death rate. In gastroschisis, there was a 50% cesarean section rate, with a 50% neonatal death rate. Vaginal delivery was associated with a 25% death rate. There is no evidence that cesarean section offers improved neonatal survival.

Hemopericardium resulting from attempted internal jugular vein catheterization: a case report and review of complications of central venous catheterization

An unusual case of hemopericardium and presumed fatal cardiac tamponade complicating attempted right internal jugular vein catheterization by the posterior approach is reported. Reports of complications in a series of internal jugular vein catheterizations using various approaches (posterior, central, anterior, supraclavicular) and subclavian vein catheterizations are reviewed. Internal jugular vein catheterization is not necessarily safer than subclavian vein catheterization: numerous factors determine success rate and complication rate in central venous catheterizations.

Retrospective post-marketing surveillance of Transiderm-Nitro 5 in general practice in the United Kingdom

A retrospective post-marketing surveillance of Transiderm-Nitro 5 was undertaken in 1803 general practice patients with various degrees of severity of angina. Over half the patients were assessed more than 3 months after starting treatment. At the time of assessment two-thirds of the patients were continuing with their Transiderm-Nitro therapy. Only a small proportion (3.8%) of the total patient population were withdrawn after 3 months' usage. This suggests the continuing benefit of longer term Transiderm-Nitro therapy. Subjective assessment of a reduction in the number of anginal attacks and an improvement in exercise capacity occurred, respectively, in 76.2% and 62.6% of the patients. Although 16% of patients experienced problems specifically related to patch use, only 6.4% withdrew for these reasons. The incidence of headache decreased with time of usage of Transiderm-Nitro to give an over-all withdrawal of 7%. The death rate observed during the surveillance lies between that for the United Kingdom population as a whole and that for a population with angina pectoris. This surveillance shows that both patients and doctors perceived clinical benefit from Transiderm-Nitro when used in the treatment of angina.

Post-marketing surveillance of the Transiderm-Nitro patch in general practice

Post-Marketing Surveillance (PMS) of Transiderm-Nitro, a new transdermal form of nitroglycerin, was undertaken during the 6 months following its introduction to general practitioners in the United Kingdom. Two thousand four hundred and seventy-five record forms were received. Excluding the fourteen patients who died during the surveillance, treatment in the remaining 2461 was judged as effective in 80.6% of patients and was well tolerated, with 70.5% having no unwanted effects. The incidences of withdrawal from Transiderm-Nitro in all patients analyzed were 5.7% due to headaches, 3.6% due to other unwanted effects and only 3.1% due to the treatment being judged as ineffective. This PMS confirms that Transiderm-Nitro is an effective, well tolerated addition to the therapy of angina pectoris.

Septicemia after transurethral prostatectomy

Septicemia occurred in 18 of 1,604 patients subjected to transurethral resection (TUR) of the prostate. Six patients died postoperatively, 4 of septicemia. In 11 patients septicemia was provoked by TUR in the presence of urinary infection and in the absence of appropriate antibiotic cover. Septicemia was provoked by catheter removal in 2 similarly infected patients. In the remaining 5 patients the urine was sterile at operation but became infected prior to catheter removal, and this maneuver precipitated septicemia.

Pre-test epinephrine injections reverse DDC-induced retrograde amnesia

The effects of pre-test systemic administration of epinephrine on DDC-induced retrograde amnesia (RA) for discriminated Pavlovian fear-conditioning were examined in rats. Epinephrine reversed RA with the optimal dosage being 0.05 mg/kg. Apparently, the effect was specifically reversal of amnesia since (a) performance was restored to control levels, but no higher, and (b) sensitization and activity-related artifacts were minimized. These results are consistent with those showing reversal of RA by pre-test administration of hormones or catecholamine agonists. That is, they suggest that amnesia is due to a retrieval deficit rather than to failure of memory storage. Results are discussed in terms of epinephrine-induced modulation of storage and retrieval processes through central and peripheral mechanisms.

Encounter with Saturn: Voyager 1 Imaging Science Results

As Voyager 1 flew through the Saturn system it returned photographs revealing many new and surprising characteristics of this complicated community of bodies. Saturn's atmosphere has numerous, low-contrast, discrete cloud features and a pattern of circulation significantly different from that of Jupiter. Titan is shrouded in a haze layer that varies in thickness and appearance. Among the icy satellites there is considerable variety in density, albedo, and surface morphology and substantial evidence for endogenic surface modification. Trends in density and crater characteristics are quite unlike those of the Galilean satellites. Small inner satellites, three of which were discovered in Voyager images, interact gravitationally with one another and with the ring particles in ways not observed elsewhere in the solar system. Saturn's broad A, B, and C rings contain hundreds of "ringlets," and in the densest portion of the B ring there are numerous nonaxisymmetric features. The narrow F ring has three components which, in at least one instance, are kinked and crisscrossed. Two rings are observed beyond the F ring, and material is seen between the C ring and the planet.

The Galilean Satellites and Jupiter: Voyager 2 Imaging Science Results

Voyager 2, during its encounter with the Jupiter system, provided images that both complement and supplement in important ways the Voyager 1 images. While many changes have been observed in Jupiter's visual appearance, few, yet significant, changes have been detected in the principal atmospheric currents. Jupiter's ring system is strongly forward scattering at visual wavelengths and consists of a narrow annulus of highest particle density, within which is a broader region in which the density is lower. On Io, changes are observed in eruptive activity, plume structure, and surface albedo patterns. Europa's surface retains little or no record of intense meteorite bombardment, but does reveal a complex and, as yet, little-understood system of overlapping bright and dark linear features. Ganymede is found to have at least one unit of heavily cratered terrain on a surface that otherwise suggests widespread tectonism. Except for two large ringed basins, Callisto's entire surface is heavily cratered.

Coronary bypass with Gore-Tex graft

The case is presented of a 68-year-old man who previously had undergone aorta-coronary bypass. During a 3 year interval the coronary disease progressed, so that a once insignification lesion necessitated reoperation. A Gore-Tex vascular graft was chosen as a substitute because of the lack of saphenous vein. Three months posoperatively the patient's recatheterization study showed patency of the Gore-Tex graft placed in the distal righ coronary artery, and there was a satisfactory clinical result. No anticoagulants have been given to the patient after the operation.