Australian and New Zealand journal of medicine
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Six hundred and sixty-one patients with stroke, confirmed by CT scan or at autopsy, were reviewed in order to evaluate the frequency of presentation with altered mental state. Nineteen patients (3%) had presented with delirium, an organic delusional state, the acute onset of dementia, or mania, mimicking psychiatric illness. All had focal cerebrovascular lesions which were usually, but not invariably, right sided. ⋯ Neurological signs were absent or mild and transient, and therefore easily missed. Post-mortem examinations in four patients showed localised cerebral infarctions with no evidence of multiple lesions, Alzheimer's disease, or metabolic encephalopathies. The possible causative factors are discussed and the evidence of asymmetrical cerebral representation of emotion, and for a relationship with epilepsy, is reviewed.
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Of 97 Chinese patients with multiple myeloma seen over a 12-year period, 23.7% were found to have cauda equina or spinal cord compression (SCC). Predictive features for SCC include paraprotein type, hemoglobin level, and the extent of bone lesion at initial hematological diagnosis. ⋯ Our patients presented late with advanced neurological deficit so that treatment was unsatisfactory. It is emphasised that early recognition of back pain and neurological symptoms is essential, as any delay would jeopardize the chance of neurological recovery.
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Comparative Study
Benign and malignant pleural effusions in former Wittenoom crocidolite millers and miners.
Serial plain chest radiographs taken between 1943 and 1982 for 280 claimants for compensation for asbestosis and 32 claimants for malignant pleural mesothelioma from the Wittenoom asbestos industry were reviewed by two observers to identify diffuse pleural thickening and pleural effusion. A pleural effusion which appeared and resolved within two years without radiographic or clinical evidence of underlying malignancy, infection or cardiac failure was seen in 15 cases by reader 1 and 24 cases by reader 2. Eighteen cases of effusion, determined from clinical records to be caused by malignant pleural mesothelioma, were seen by reader 1 and 20 by reader 2. ⋯ The latent period for benign asbestos pleural effusion was inversely related to total cumulative exposure, whereas that for effusion due to malignant pleural mesothelioma was significantly shorter for subjects who had worked in the mill than for those who had worked in the mine. A long latent period and a history of working in the mill were significant discriminators for a malignant as opposed to a benign basis for an effusion. The appearance of a benign asbestos pleural effusion appeared to be a risk factor for the severity of subsequent diffuse pleural thickening.(ABSTRACT TRUNCATED AT 250 WORDS)
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We report two patients with inferior myocardial infarction, complicated by bradyarrhythmia, hypotension, and clinical evidence of right ventricular infarction. Conventional therapy of volume expansion and inotropic support was insufficient to maintain an adequate blood pressure. ⋯ We recommend consideration of these pacing modes in patients with inferior infarction with evidence of right ventricular infarction, bradyarrhythmia, and cardiogenic shock. The likely mechanism of improvement is by restoration of atrial transport with consequent improvement in ventricular function.