Plethysmography and the diagnosis of the steal syndrome following placement of arteriovenous fistulas and shunts for hemodialysis access.

An arteriovenous fistula, created for hemodialysis access, may on occasion produce ischemia or even gangrene of the extremity distal to the fistula. This article describes a simple plethysmographic test which will accurately differentiate a steal syndrome from other causes of ischemia, pain, or necrosis and will allow the surgeon to remedy the problem in a specific way.

Roentgen aspects of isolated pulmonary valvular stenosis on chest plain films.

Isolated pulmonary valvular stenosis shows a typical radiological pattern in 70% of the cases, including bulging of the left middle and the right inferior segments, a convex left inferior segment and an upwards shift of the apex. In quite a lot of cases (28%), only one of the four above mentioned criteria, are found, mainly the bulging of the left middle segment. There is a small percentage (6%) of cases with an atypical radiological pattern or showing total normality (5%). There is a clear connection between the cardio-thoracic index and the degree of the stenosis but there is no connection between the severity of the stenosis and the degree of bulging of the left middle segment. However the plain chest film has no value for prognosis (evaluation of the degree of the stenosis) nor to follow the post operative course of this frequent congenital abnormality.

[X-ray computed tomographic aspects of tumors of the colon with peripheral extramucous development]. / Aspects scanographiques des tumeurs du côlon à développement extra-muqueux périphérique.

The authors report three cases of a palpable abdominal mass without clinical evidence of obstruction. In each case, ultrasound diagnosed a solid tumor. Computer tomography examination measured the density of the tumor and the extension of the disease. In each case, the colonic origin was established owing to surgery. Histological examination of the three cases diagnosed a fibroma of the caecum, an enterogenic cyst of the caecum and a T-lymphosarcoma developed from the wall of the left colon.

Assessment of an Australian medical internship.

The work patterns of interns were observed, recorded and analysed into categories descriptive of service and training functions. As would be expected, the service component predominated, while only 7-13% of interns' time could be identified as educative. Interns make little use of formal postgraduate educational sessions and visit the library rarely. They acquire the necessary clinical skills and attitudes to fit them for future practice largely by osmosis and from discussions with residents and registrars. Consultants play only a small role in their education . Non-formal education, which is acquired as part of the service function, has the most potential for effective training. Its unsystematic character, however, may present a problem for both interns and their supervisors since neither may have a comprehensive view of what requires to be learned or what progress is being made. There is a need for interns and their supervisors to identify the learning objectives and experiences which they should attain during each term.

Anorexia tardive--late onset marital anorexia nervosa.

Most cases of anorexia nervosa start in adolescence but a sizeable number can develop the condition at any late age. The term Anorexia Tardive is reintroduced to describe woman who develop anorexia nervosa at or after the time of their marriages. The paper reports the study of the background and personalities of 50 such women, together with their husbands in 45 cases, and the parts played by both in the condition. The women were divided into 4 groups; those who developed Anorexia Tardive (1) in the engaged period, (2) after marriage and before pregnancy, (3) after childbirth and (4) at or after the menopause. In the first three groups Anorexia Tardive developed as a maladaptive solution to a growing marital crisis. Many of the husbands were immature men who readily accepted a sick dependent wife. Group 4 women differed in a number of respects and their loss of weight ultimately came to express a desire to die. Outcome and prognosis are described.

[Spasm of the renal and digestive arteries. Radiologic aspect]. / Le spasme au niveau des artères rénales et digestives. Aspect radiologique.

Spasms of the mesenteric and renal arteries are of great concern to the radiologist specialized in angiography. In most cases, they appear to be of iatrogenic origin, due to difficulties in selective catheterization and especially in superselective catheterization of the mesenteric and renal arteries. In this case, spasm may be a most unwelcome side-effect. In other less frequent cases, spasms appear as indirect signs of an underlying spasmogenic disease, such as G. I. tract carcinoid, pheochromocytoma, pancreatitis or poisoning such as ergotism or digitalis overdosage. Most of all, it may occur during some non-occlusive intestinal ischemias. On the other hand, spasm can be considered as a way of treatment, especially in cases of G. I. bleeding, particularly due to ulcerations.

Psychometric rating in the assessment of progress in anorexia nervosa.

Personality variables and psychiatric symptoms were each assessed by inventory in 42 patients with anorexia nervosa: as in-patients initially, and during a three-year follow up. The results were used to distinguish primary from secondary cases and to monitor the clinical progress of the disorder.

Capgras: case study and reappraisal of psychopathology.

A case of the Capras phenomenon in a man of 58, arising during the course of a depressive illness, is described. Physical, electroencephalographic and psychometric investigations gave no sign of organic disease, and recovery was complete. Factors leading to the development of a depressive psychosis and its particular manifestation in the Capgras delusion are traced in detail. The psychopathology of the condition and the implications for treatment are discussed.