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R L Kramer

Publications and source records attributed to R L Kramer.

At least 37 records · Page 2Linked to original sources
PubMed1991

The Rorschach M response: a return to its roots.

The Exner (1986) system of scoring of the Rorschach results in a human movement response (M), which is far afield from Rorschach's original intent. This divergence can easily lead to faulty interpretations of a record as there is no need for kinesthetic reactions on behalf of the subject in Exner's system. The need to return to a traditional view of the M is demonstrated through a focus on theory and the literature that illustrates Rorschach's intent. The alteration of the M results in a scoring system which, due to its differences, must come up with a separate interpretative system and not consider itself part of the Rorschach system that Rorschach envisioned.

Color Perception↗
PubMed1989

The treatment of childhood night terrors through the use of hypnosis--a case study: a brief communication.

Night terrors are nocturnal episodes of intense autonomic arousal which are manifested by loud shouting or screaming in terror. The sufferer is not awake and is generally completely amnestic for the episodes. Night terrors and other sleep disturbances, such as somnambulism, are disorders of arousal (Broughton, 1968; Fisher, Kahn, Edwards, & Davis, 1973; Guilleminault, 1987). A 10-year-old white male was treated for a 6-year-long bout of night terrors. The hypnotic induction consisted of the finger lowering technique where the middle 2 fingers were raised and the individual was asked to watch the fingers as they "go to sleep." He was given suggestions for dropping off to sleep gradually and for rotating cycles of sleep. The regularity and continual movement of the cycles of sleep were emphasized. He was also given direct suggestions for not dropping too quickly into an extremely deep stage of sleep. He has not had a recurrence of night terrors since that time (approximately 2 years). Psychodynamic issues are discussed as is the need for further research.

Arousal↗
PubMed1983

Word frequency effect and recognition memory in dementia of the Alzheimer type.

Normal persons show better recognition memory for rare than for common words. In the first experiment, we examined this word frequency effect in 17 patients with dementia of the Alzheimer type (DAT) and 20 normal controls of equivalent age and education. The DAT patients showed a normal tendency to false alarm to common words but failed to show the normal rare word advantage in their hit rate. In a second experiment, we examined normal memory immediately and after a delay of 1 week when it is approximately equivalent to that of DAT patients. There was no attenuation of the usual rare word advantage. These findings suggest that DAT patients fail to encode the featural and intrastructural elements of to-be-remembered verbal information and that this processing deficit may contribute to their impaired recognition memory performance.

Adult↗
PubMed1983

Urinoma in Pregnancy.

Urinoma, or pararenal pseudocyst, is most frequently the result of trauma. The patient described here presented with symptoms and signs of pyelonephritis, the diagnosis of which was not confirmed bacteriologically. Further investigation led to the diagnosis of urinoma. The pathogenesis and treatment are described.

Adolescent↗
PubMedDate not supplied

Does labetalol predispose to pulmonary edema in severe pregnancy-induced hypertensive disease?

We investigated whether use of labetalol, a beta adrenoreceptor blocking antihypertensive agent commonly employed as an alternative to hydralazine, is independently associated with pulmonary edema in women with severe preeclampsia. We retrospectively evaluated women with severe preeclampsia who were given labetalol by intravenous bolus for MAP > 120 mm Hg. Outcome variables included: achieving MAP < 120 mm Hg with < 300 mg of labetalol, incidence of adverse effects of the drug, including pulmonary edema, hypotension, and maternal bradycardia. Total intravenous fluid intake exceeding output (+ delta I/O) and presence or absence of preeclamptic liver involvement were noted. Statistical analysis included unpaired t-tests and Fisher's exact test. Fifty-one women were studied, 7 (13.7%) of whom developed pulmonary edema. Demographic and pregnancy characteristics were not different between patients who did or did not develop pulmonary edema. No patient had detectable underlying heart disease. Patients with or without pulmonary edema did not differ as regards entry MAP (130 +/- 14 vs. 129 +/- 18 mm Hg), total dose of labetalol (209 +/- 83 vs. 193 +/- 39 mg/24 hours), incidence of bradycardia or hypotension (0/7 vs. 8/44), or presence of hepatic involvement (1/7 vs. 9/44). However, there was a significant difference in degree of positive fluid balance. Patients developing pulmonary edema had a net gain of 1,466 +/- 429 mL of fluid in the 24 hours in which they received labetalol than those who did not (659 +/- 1152 mL, P = .003). Initial central hemodynamic monitoring data revealed no impairment of cardiac performance (mean cardiac output 7.7 +/- 1.8 L/min, cardiac index 4.0 +/- 0.8 L/min/m2, left ventricular stroke work index 73 +/- 9 g.m.m-2) despite high pulmonary capillary wedge pressures (22 +/- 4 mm Hg). We conclude that the incidence of pulmonary edema in patients with severe preeclampsia who are treated with labetalol appears to be a result of an increase in third space fluid accumulation as a manifestation of the severity of their disease, not a direct effect of the drug on cardiac performance.

Adult↗
PubMedDate not supplied

Prenatal diagnosis of cloacal dysgenesis sequence: differential diagnosis from other forms of fetal obstructive uropathy.

Cloacal dysgenesis sequence (CDS) is a rare cause of fetal obstructive uropathy (FOU). The prenatal differentiation of CDS from other FOU is important because CDS is not amenable to in utero surgical intervention in the form of vesicoamniotic shunts. We evaluated the prenatal characteristics of 8 fetuses with CDS, including a pair of monozygotic twins concordant for CDS, in order to identify features that would enable differentiation from other forms of FOU. Pathologic examination in each of the 8 fetuses confirmed characteristic features of absent anal, genital, and urinary orifices associated with a smooth perineum and abnormal phallic development. Associated abnormalities included dysplastic kidneys in 6, hydroureters in 5, intraluminal colonic calcifications in 2, and hypoplastic lungs in 5. Five of these fetuses initially presented as posterior urethral valve syndrome. Six fetuses had megacystis, and 4 underwent vesicocenteses to evaluate urinary electrolytes, all of which were in the 'poor-risk' category. Six fetuses were male and 2 female, contradicting earlier claims that CDS occurs only in females. Evaluation of candidates for in utero surgical intervention should include fetal karyotype, and CDS should be suspected in cases of FOU in whom the karyotype reveals a male fetus and sonographic evaluation demonstrates colonic calcifications or abnormal phallic development. Diagnostic microendoscopy may be of benefit in such cases.

Adult↗
PubMedDate not supplied

Pastoral care utilization among women electing pregnancy termination for fetal anomalies.

OBJECTIVE: To identify determinants of requesting pastoral care (PC) at the time of pregnancy termination for fetal anomalies. METHODS: PC was provided by a hospital-based chaplain. Data were reviewed for 88 women who elected pregnancy termination. Nominal logistic regression and Kruskal-Wallis and Student t tests were used as appropriate. RESULTS: None of 37 women who underwent dilatation and curettage (D&C) or dilatation and evacuation (D&E) requested PC as compared with 40 of 51 patients who underwent prostaglandin induction of labor (p < 0.001). The decision to seek PC was related to gestational age (p < 0.001), but not to maternal age, prior termination of pregnancy, gravidity, parity, racial background, or insurance status. The gestational age was also a significant predictor of the procedure performed (p < 0.001). D&C/D&E were significantly more likely to be performed at earlier gestational ages. Women seeking PC were less likely to have experienced previous pregnancy loss or the death of a child. Among women who sought PC, 20% had experienced previous pregnancy loss or the death of a child, as opposed to 54% of women in the prostaglandin group who did not seek PC (p = 0.03). In the D&C/D&E group, the figure was 46%. CONCLUSIONS: Utilization of PC is much more frequent among women undergoing prostaglandin induction of labor than D&C/D&E. Determinants of seeking PC are related to issues congruent with choices of the termination procedure. Patients who experienced a previous pregnancy loss or the death of a child are also less likely to feel the need, or do not want, chaplaincy involvement.

Abortion, Induced↗
PubMedDate not supplied

2nd-trimester maternal serum marker results are not altered by delayed analysis.

OBJECTIVE: The goal of the study was to evaluate the significance of delayed laboratory analysis of maternal serum alpha-fetoprotein, beta-subunit of human chorionic gonadotropin, and unconjugated estriol for prenatal screening. METHODS: Biochemical analysis of 30 consecutive biochemical screening specimens of maternal serum alpha-fetoprotein, beta-subunit of human chorionic gonadotropin, and unconjugated estriol was performed immediately upon arrival to the laboratory, 7 days later, and again 14 days after maternal blood was drawn. Differences among the results of the three sets of biochemical studies were evaluated by one-way analysis of variance for repeated measures. RESULTS: No significant differences were found among the results of immediate assays as compared with those at a 7- or a 14-day delay for all three biochemical markers. CONCLUSIONS: Our data suggest that up to a 14-day delay in the performance of the 2nd-trimester maternal serum biochemical screening assays will not alter the results significantly. The results of maternal serum screening are, thus, clinically valid even if the laboratory assays were performed several days after maternal blood was drawn.

Adolescent↗
PubMedDate not supplied

Amnioinfusion in the evaluation of fetal obstructive uropathy: the effect of antibiotic prophylaxis on complication rates.

OBJECTIVE: Amnioinfusion plays an important role in the intrauterine evaluation and treatment of fetal obstructive uropathy. However, it may significantly increase the risk for chorioamnionitis, premature rupture of membranes and premature labor. We evaluated the impact of prophylactic antibiotics on postamnioinfusion complications. METHODS: Thirty pregnancies complicated by fetal obstructive uropathy, treated by amnioinfusion and with documentation of pregnancy outcome were identified from our database. Pregnancy outcomes were compared between patients who were treated with prophylactic antibiotics and those with no prophylaxis. RESULTS: Chorioamnionitis was diagnosed in 3 out of 15 (20%) patients who did not receive prophylactic antibiotics as compared to 2 (13%) in the treated group. The overall rate of serious obstetrical complication was significantly higher in the untreated group (66 vs. 20%; p = 0. 021). Patients receiving prophylactic antibiotics delivered at a significantly greater gestational age than those who did not receive antibiotics (34.0 +/- 3.7 vs. 31.3 +/- 1.9 weeks, respectively; p = 0.018). CONCLUSIONS: Our study supports the use of oral prophylactic antibiotics as being effective in reducing the previously observed significant risks associated with amnioinfusion in fetal obstructive uropathy.

Amnion↗
PubMedDate not supplied

Trisomy 21 placentas: histopathological and immunohistochemical findings using proliferating cell nuclear antigen.

OBJECTIVE: The cause of growth retardation in trisomy 21 and other autosomal trisomies is not known, but may be the result of defective cell proliferation, slowing of the cell cycle, or placental structural abnormalities. Abnormalities of the fetal cell cycle may be reflected in placental growth and can be detected using proliferating cell nuclear antigen (PCNA). METHODS: Twelve second-trimester and six third-trimester trisomy 21 placentas were examined histopathologically and stained immunohistochemically using antibodies to PCNA. Normal age-matched placentas were used as controls. RESULTS: The second-trimester trisomy 21 placentas all exhibited many large irregular hypovascular villi. The third-trimester trisomy 21 placentas showed two patterns: (i) many large, irregular hypovascular villi, and (ii) relatively normal-appearing villi with only a few abnormal villi and focal hypervascularity. PCNA staining was significantly greater in second-trimester placentas when compared to third-trimester placentas for both trisomy 21 and controls. There was no significant difference in PCNA staining in trisomy 21 placentas when compared to the normal age-matched controls. CONCLUSIONS: PCNA staining indicates no significant differences in proliferation between normal and trisomy 21 placentas. Trisomy 21 placentas show villus abnormalities, including hypovascularity.

Chorionic Villi↗
PubMedDate not supplied

Concordance for cloacal dysgenesis.

Monozygotic (MZ) twins concordant for cloacal dysgenesis were diagnosed at 15 weeks' gestation on ultrasound exam. The structural alterations result from abnormal morphogenesis of the cloacal membrane and contiguous anlage with resultant secondary changes. These defects are suggestive of teratogen exposure or an endogenous event early in gestation, resulting in MZ twinning and the development of a polytopic field defect.

Cloaca↗