Thrombocytopenia.

Emergency physicians often must evaluate patients with thrombocytopenia. Once recognized, the initial concern is for evaluating the patient's hemostasis. Prompt diagnosis and early intervention may be life saving. This article reviews platelet function and kinetics and presents the pathophysiology and clinical and laboratory findings of a number of diagnoses that are included in the differential diagnosis of thrombocytopenia. The general as well as specific approach to the patient is outlined.

Hypnoanesthesia in the morbidly obese.

The advent of chemical anesthesia relegated hypnosis to an adjunctive role in patients requiring major operations. Anesthesia can be utilized with acceptable risk in the great majority of patients encountered in modern practice. But an occasional patient will present--such as one with morbid obesity--who needs a surgical procedure and who cannot be safely managed by conventional anesthetic techniques. This report describes our experience with such a patient and illustrates some of the advantages and disadvantages of hypnoanesthesia. The greatest disadvantage is that it is unpredictable. Close cooperation between the patient, hypnotist, anesthesiologist, and surgeon is critical. However, the technique may be utilized to remove very large lesions in selected patients. Hypnoanesthesia is an important alternative for some patients who cannot and should not be managed with conventional anesthetic techniques.

Detection of faking on the Halstead-Reitan neuropsychological test battery.

Administered the Halstead-Reitan neuropsychological test battery to a heterogeneous sample of 52 brain-impaired patients and 202 non-impaired college and community volunteers. The volunteers were assigned randomly to either the control group or to one of four faking groups, which differed only in terms of type of brain damage Ss were to fake. The Right and Left groups were told to fake unilateral damage to only one hemisphere, the Diffuse group was told to fake damage to both hemispheres, and the Nonspecific group simply was told to fake brain damage. The author achieved a hit rate of 94.4% on subjective classification of a subsample of 195 Ss into brain-impaired vs. non-impaired categories. Stepwise discriminant analysis of the entire sample yielded two functions that achieved hit rates of from 94.9% to 97.2% for various base rates of malingering. Discrimination between control and faking Ss was much less accurate, and the latter were highly unsuccessful at generating believable patterns of lateralized cortical impairment. Posttest interviews were conducted to obtain information concerning faking strategy as well as factors that inhibited or facilitated the efforts to fake.