A case for stress counselling.
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Biomedical subjects
Publications and source records attributed to C Spiers.
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Crisis counselling can be effective for many employees--not all in traditionally 'high risk' occupations--and can negate the long-term effects of trauma. Carole Spiers suggests ways of introducing effective procedures for post-trauma counselling.
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We report a case of pulmonary embolus which is presumed to have been of trophoblastic tissue in a woman in her second pregnancy who had a hyperactive hydatidiform mole. (The size of the uterus was 27 cm after thirteen weeks of amenorrhoea. The level of urinary H.C.G. was greater than 2 million international units per litre.) One hour after the uterus had been evacuated under chemotherapy a picture of acute dyspnoea appeared, and this made it necessary to transfer the patient to an intensive care unit and to incubate her and ventilate her. The analysis of the blood gas showed desaturation and hypoxaemia leading to a diagnosis of massive pulmonary embolus. These complications were resolved in 72 hours and the levels of H.C.G. went down later under the influence of chemotherapy which was started one month after the evacuation and continued for fourteen weeks (for six weeks after the plasma H.C.G. levels had become negative).
Chemodectomas in the carotid fork are rare and usually benign tumours. Their removal by surgery creates certain problems in terms of operating technique since they are, anatomically, awkwardly situated. An additional problem arises from loss of blood resulting from their removal and possible cardiac disturbance which might affect the functioning of the carotid sinus should the tumours have been situated in this region. Furthermore, the possible eventuality of having to clamp the internal carotid for a short or even long time, should the operation require it, presupposes a perfect knowledge of the patient's cerebral circulation. Hence, therefore, the necessity of a verification of this circulation by centrolateral carotid arteriography to confirm the permeability of the circle of Willis and a potentially good supply of blood when the blood in the region of the tumour is restricted. It is equally necessary to have a complete record of the general state of the patient's cardiovascular, circulatory, respiratory, renal and neurological conditions. These must, within certain limits, be deemed satisfactory before the decision to operate is taken. Indeed, it is these conditions that will determine the per-operative as well as the post-operative condition of the patient.
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