Parasellar chondromyxofibroma with ipsilateral total internal carotid artery occlusion

A case of parasellar chondromyxofibroma with ipsilateral total internal carotid artery occlusion is presented. Its radiological appearance and its pathological characteristics are discussed and compared with previously published reports. The rare association with total internal carotid artery occlusion is reviewed.

Physicians' and the public's attitudes on communication about death

We studied the preferences of physicians and the public as to how physicians should inform a family of a patient's unexpected death. When the family had to be reached by telephone, 72% of our 150 physician-respondents preferred telling the family that the patient was critically ill and asking the family to come to the hospital immediately (critical notification [CN]); 25% of the physicians preferred announcing the death over the telephone (death notification [DN]). When the news had to be announced in person, 58% of physicians preferred immediately announcing it (IA), and 33% preferred gradual announcement (GA). A Gallup poll commissioned by us showed that 64% of the adult population in the United States preferred CN, 26% DN, 79% IA, and 17% GA; CN and IA were preferred in all the demographic subgroups examined. We discuss our findings, the reasons for them, and their ethical and practical implications.

Development of agoraphobia after surviving cancer

We present a case conference on a 32-year-old accountant who developed embryonal carcinoma of the testis, two months after the birth of a son with a missing leg. His cancer was successfully treated with surgery and chemotherapy. After 5 years, when he was told that he need not be closely followed by his physicians anymore because he had been cured of cancer, he developed agoraphobia with panic attacks. This interfered with his occupational and social adjustment. His phobia was treated successfully with pharmacotherapy, behavior therapy, and psychotherapy. We explore the psychologic impact of cancer, the activation of separation anxiety and aggressive impulses after its successful treatment, the crippling nature of his agoraphobia, and the ingredients of his successful response to treatment.

Alzheimer's disease in a patient on long-term hemodialysis: a case report

This case report describes a progressive dementia in a 49-year-old black male on long-term hemodialysis. The initial presentation simulated depression. The dementia persisted after an unsuccessful cadaver homograft transplant. The character of the dementia was nonspecific but typical features of dialysis dementia were lacking. Autopsy revealed a ruptured cerebral aneurysm, polycystic kidneys, moderately severe atherosclerosis, miliary tuberculosis, and neurofibrillary degeneration of the hippocampus. The significance of a possible relationship between end-stage renal disease (ESRD), hemodialysis, and Alzheimer's disease in this case is discussed.

The experience of myocardial infarction as a threat to one's personal adequacy

This report of a clinical case conference on a 40-year old man with acute myocardial infarction is presented in a format that readers of this journal may find useful in their teaching of health professionals and students. The report illustrates some psychologic aspects of myocardial infarction and the impact it had on this particular patient. In this case, the myocardial infarction reactivated some underlying unresolved conflicts about personal adequacy that the patient had previously kept under check by some fragile defense mechanisms. Thus, it disrupted the personality organization and produced emotional upheaval and maladaptive behavior. This in turn was deleterious to the patient's physical health. This case, therefore, illustrates the importance of the biopsychosocial approach in the understanding and treatment of medical illness.