Palinopsia: a review of the literature.

The literature on palinopsia (visual perseveration) is reviewed, utilizing case reports of 46 patients who demonstrated this symptom. The most common etiologies for this symptom are space-occupying lesions, cerebral infarct, and seizure activity. The vast majority are due to central nervous system pathology occurring in the posterior (occipital or parieto-occipital) region, often in the right hemisphere. Proposed mechanisms for palinopsia are also discussed.

Association of attending physician specialty with the cesarean delivery rate in the same patient population.

BACKGROUND AND OBJECTIVES: In the context of a dramatic increase in US cesarean delivery rates over the past 30 years and explicit national goals to decrease the cesarean rate, previous retrospective studies have shown that pregnant women cared for by family physicians may be less likely to undergo cesarean delivery, compared with patients cared for by obstetricians. METHODS: We conducted a retrospective chart review of 3,560 deliveries from the family practice service of a community-based family practice residency from 1986-1995, focusing primarily on cesarean delivery rates during two periods of time. During period 1 (n = 1,063), all attending were private practice obstetricians. After a transition period, all births were attended by family medicine faculty (period 2, n = 1,346). RESULTS: The total cesarean delivery rate declined from 16.7% in period 1 to 11.1% in period 2. Repeat cesareans declined from 8.5% to 2.9%. CONCLUSIONS: In this community-based residency, a change in the specialty of the attending physician was associated with a 34% decline in the cesarean delivery rate. The observed decline in the cesarean rate could not be accounted for by any change in patient demographics or secular trends in cesarean delivery rates.

Screening for cancer: evaluating the evidence.

Many patients expect to undergo screening tests for cancer. In evaluating screening procedures, physicians must take into account the known effects of lead time, length and screening biases, all of which can result in an overestimation of the benefits of screening. The gold standard by which a screening test is evaluated remains the prospective, randomized controlled trial, demonstrating reduced morbidity and mortality. The magnitude of benefit from screening is best expressed in terms of the number of patients needed to screen. This value ranges from approximately 500 to 1,100 for proven screening interventions. These concepts are illustrated by controversies in current screening recommendations for cancers of the cervix, lung, colon, breast and prostate, which together account for more than 50 percent of cancer deaths in the United States.

Palinopsia posing as a psychotic depression.

The experience of visual images appearing as well-described persons and objects, either familiar or unfamiliar to the patient, has frequently prompted psychiatric evaluation for apparent psychotic or schizophrenic disorders. A case of apparent psychotic depression is reported, in which the symptoms were due to the patient's experience of palinoptic images. Answers to particular questions in the initial interview can obviate the need for psychiatric consultation, as various consistencies have been reported in the non-psychiatric symptom of palinopsia.