The diagnosis of adult onset Still's disease is difficult in the absence of definite clinical and laboratory criteria. A delayed diagnosis of adult onset Still's disease was made in a 23-year-old female who developed multi-organ failure and disseminated intravascular coagulation with fingertip auto-amputation during a febrile illness considered septic due to the persistence of elevated serum procalcitonin concentration.
SUMMARY We report a case of Alexander's disease in a black South African boy of 9 years. The child presented with a grossly abnormal stooped posture, generalised weakness, and slurred nasal speech. Computerised tomography revealed diffuse low radio-density confined to the white matter, and enlarged ventricles. Cerebral biopsy confirmed the diagnosis. The histopathological and electron microscopic features are essentially the same as those described in previous reports. We note the presence of dense clumps of material within some of the Rosenthal fibres, and can find no reference in the literature describing this. Sural nerve biopsy was normal.Case report A black South African boy child aged 9 years and 5 months was first seen at Baragwanath Hospital in July 1978. A rather inadequate history was supplied by his sister. His main complaints were difficulty in walking because of painful knees and backache, and generalised weakness for approximately one month. The patient has six healthy siblings, and his own birth and milestones were apparently normal. From the clinical appearance of the child we considered that he had been ill for longer than the history indicated.He was a thin black male child with a head circumference of 570 mm. He had a strikingly abnormal stooped posture, with flexion of the neck, drooping of the shoulders, and flexion of both hip and knee joints (Fig. 1)
The case highlights the importance of early recognition of the symptoms and signs of endogenous endophthalmitis in any patient with systemic infection by all clinicians and the necessity of prompt ophthalmological referral if a useful level of vision is to be preserved.
SUMMARYTwo aspects are involved in the image of the nursing profession -the public image and the self-image.The public image has been improving but is negatively influenced by the image presented in the media which does not usually reflect professionalism.The self-image held by the profession is even more important than the public image as this determines the profession's influence in health services. The profes sion's group image is determined by the self-image of individuals in the group. The self-image is influenced by external factors, such as support and encourage ment by other nurses, and by internal factors such as the nurse regarding her work as a calling. INLEIDINGDie huidige tek o rt aan verpleeg kundiges in die R SA regverdig nie net die regstelling van die salarisstru k tu u r nie, m aar noodsaak ook 'n introspeksie van die beeld van verpleging soos deur die publiek, die professie en individuele ver pleegkundiges verbeeld word. D at verpleegkundiges asook die verplegingsprofessie wel besig is om die beeld van verpleging onder die soeklig te plaas, w ord bevestig d eur talle artikels in professionele tydskrifte op internasionale gebied, navorsing en gesprekke onder ver pleegkundiges. 'n A nalise van hier die artikels dui daarop dat die selfbeeld van verpleegkundiges m eer aandag kry as enige ander onderw erp. Basiese tem as in die ver p le e g k u n d ig e ty d s k r if te o m s lu it hoofsaaklik die pligte en funksies van die verpleegkundige, verantw oordelikheid aan die sam elewing, verpleegonderw ys, navorsing, leierskap, en verhoudinge m et ander professionele w erkers. D aar word tot die gevolgtrekking gekom dat hierdie preokkupasie van verpleeg kundiges m et die selfbeeld van die allergrootste belang is.Die beeld van die verplegingspro fessie en van individuele verpleegpraktisyns sentreer om twee asp ekte, naam lik die kwessie van die publieke beeld en die selfbeeld. DIE PUBLIEKE BEELDN avorsing toon dat die beeld van die rol van verpleegsters in die verlede beperk was tot tradisionele pligte en take in hospitale en geneeshere se spreekkamers, wat nie veel intelligensie geverg het nie (A ndrew , 1981:587).Teen ongeveer 1979 het die pu blieke beeld van verpleging aansienlik verbeter, veral m et betrekking tot die publiek se persepsie van verpleegonderw ys en die verpleeg kundiges se status as professionele gesondheidsw erkers (A lexander, 1979:654). Dit kan w aarskynlik toegeskryf word aan die toenem ende betrokkenheid van verpleegkun diges in die gesondheidsbehoeftes van die gem eenskap, die voortgesette hoë kw aliteit van verplegingsdienste en die em patie van baie ver pleegkundiges teen o o r die lede van die publiek wat verpleegdienste ontvang (M aryland: 1979:695).In kontras m et hierdie m eer positiewe beeld is daar tog baie subtiele sinjale wat vanuit die m edia deurstraal. O p televisieprogramme word verpleegkundiges gevind wat hier en daar 'n kussing regskud, m e disyne of 'n inspuiting toedien en panne dra. H ulle funksie reflekteer nie professionele verpleging nie. In verhouding tot h...
Psychological and spiritual support of the dying patient involves establishing a relationship of trust, which requires special communication skills. Health professionals are not usually trained in these skills and they tend to dissociate themselves from dying patients and their relatives. An analysis of the communication proses enables us to improve our own pattern of communication. Firstly, counselling requires that we direct our attention — by eye contact, our position, listening and conversation. Various techniques may be used to improve conversation, such as the use of open and closed questions and paraphrasing. One must also be aware of the role of non-verbal communication. Secondly, confrontation is a technique used to stimulate exploration of topics which the patient is avoiding. The dying person is still a living human being and we should talk to him about the same things and for the same reasons we would talk to anyone else — because we are interested in him as a person
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